PMT16-03773 City of Menifee Permit No.: PMT16-03773
29714 HAUN RD. Type: Residential Plumbing
<A-CCELi;> MENIFEE, CA 92586
SIR- MENIFEE Date Issued: 11/2212016
P E R M I T
SiteAddress: 27166 STARK ST, MENI FEE, CA 92586 Parcel Number: 335-314-012
Construction Cost: $3,200.00
Existing Use: Proposed Use:
Description of INSTALL DUAL SWEEP CLEAN OUT ON EXISTING SEWER LINE
Work:
Owner Contractor
DAVID BIGELOW A R S AMERICAN RESIDENTIAL SERVICES OF
27166 STARK STREET CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9012719700
ANDREW ALLEN License Number: 765155
A R S INC DBA RESCUE ROOTER
1520 W LINDEN STREET
RIVERSIDE, CA 92507
Fee Description ON Amount
Sewer 1 150.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 7.50
$185.60
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA BIdgPermit Templalespt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I herebyaffirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Cha pterg(commencing With section 7000)of Division 3 of the Business and a I a in exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Uicense No By my signature below I acknowledge that,except for my personal residence
Expires Signature inwhich I must have resided for at least one year prilorto completion of
improvements covered by this permit.Icannotlegallysella structurethatl
WORKE RATION have built as an owner-builder if it has not been constructed in its entirety by
ci I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professilons Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.leginfo.ca.Roy/calaw.hitiml.
Policy It Date
�aave and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
tection 3700 of the La bor Code,for the performance of the work for which a my signature below I certify to each of the follomflng:I a m the property
y
a Y
this permit is Issued.My worker's compensation insure nce carrier and policy 6w'pnm,,r authorized to act an the property owner's behalL I have read this
numberarel application and the information I have provided is correct.I agree to comply
with all applicable city and coun orhances and state laws relating to
Carde P bMuildingcostru I au!W��representatives of this city or county to
Policy# d J(q I I Expires (b I ff enterth rty for inspection purposes.
(This section need not to be completed Is the permit is flr-o ne-hundred —Date— Ylx/fij;
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
',�ciertlfy that in the performance of the work for which this permit is issued,
I shall not emplo any persupf.n any manner s�p to become subject to the CITY BUSINESS LICENSE#
worker's compei 0 ales of 9107.ia,3 WAree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the w4 �.--n:=.ms en sofSection3700 fth Labo
Code,I shall Fin Ions. Will the applicant or future building occupant handle hazardous material or a
Applic Date'aO/' mixture containing a hazardous material equal to or greater that the
1. amounts sPofied on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKEFVS COMPENSATIOdCOVERAGE 15 oYes ,dNo
UNLAWFUL,AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,001)),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQM D)?See perm filing checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST�AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY 0 Yes -d6`0
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or madified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) 0yes I-Ao
OWNER BUILDER DECLARATIONS I have read the Haze rdo"aterial Information Guide and the SCAQM D
permitting checklis rnder my require under the State of
I hereby affirm under Pena Ity of perjury that I am exempt from the California HeaItb-4?t 'f:' e,Section and 25534 concerning
Contractoes License Law for the reason(s)indicated below by the hazardousr1.1i, !Pdeo,
, ; dfrllogg.,,�
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 "�e, 0
Business and Professions Code).Any city or county that requires a permit to Date 'i, hi�
construct,after,improve,demolish or repair any structure,prior to its Z4'ROPEKfY OWN ER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING fRRPI
License Law(Chapter 9(commencing With Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from Rcensure receiving compensation for most work that disturbs paint In a pre-1978
and the basis for the alleged exemption.Any Violation of Section 7031.5 by residence or childcare facility to be RRP�certffiied firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
m 1,as owner of the property,or my employee With wages as their sole employees.For more information about EPA!s Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.gQvIlead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a ri An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Bulderwill have the burden of proving that it was
not built or improved for the purpose of sole. cr No EPA Lead-Safe Certified Firm is required for this project because:
a 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractoes State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
, �"Menifee
DATE PERMIT/PLAN CHECK NUMBER Vmu - n
TYPE: []COMMERCIAL 13701DENTIAL F]MULTI-FAMILY []MOBILE HOME F]POOL/SPA F]SIGN
SUBTYPE: F]ADDITION F]ALTERATION F]DEMOLITION [-]ELECTRICAL DMECHANICAL
F]NEW E31�-UMBING [:]RE-ROOF-NUMBEROFS0,UARES_
vi ��wfer
DESCRIPTION OF WORK f.6L)oo� --)n -,e"cr hoe-
0' Menifee
PROJEcTADDRESS ",q' a
Buildin Safety Deot.
ASSESSOR'S PARCEL NUMBER LOT _ TRAM 2 2 2016
OWNER NAME
ADDRESS C-A qq8weived
PHONE ��q S. g I 0C)K3 EMAIL
APPLICANT NAME Wat.)
ADDRESS IS-4& ii) (-je-�s Ik C�A qW-7
PHONE 22�1,�q I ��'i EMAIL
CONTRACTOR'S NAME 965cue- A00f-eI,- OWNERBUILDER? [_-]YESO'NO
BUSINESS NAME
ADDRESS I S�o v� id�l (,A IIAV7
PHONE EMAIL
CONTRACTOR'S STATE LIC NU MEER 11(05� NSE CLASSIFICATION if,3(,�7
VALUATION$ L SO FT
11
APPLICANT'S SIGNATURE DATE
WCWFS—TAFV&.Sr0VLf'' -rI �
DEPARTMENT DISTRIBUTION I CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING P"NIVING ENGINEERING FIRE FGREENFI— SMIP
INVOICE 1 0
AMOUNT '6 6!> 1 PAIDAMOUNT t&5-f2�OCASH OCHECK# OCREDITCARD VISVMC
PLAN CHECK FEES I PAIDAMOUNT 0 CASH C)CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES C) NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-5777
www.cityofmenifee.us;Inspection Request Line 951-246-6213
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city, of Menifee
Building & Safety Dept.
NOV 2 2 2016
Received
CITY OF NIFEE---
BUILDING AND SAFETY DEPARTMENT
PLAN APPROVAL
REVIEWED BY L-P
DATE
*Approval of these plans shall not be construed to be a permit for,or an
approval of,arty violation of any provisions of the federal,state or city
regulations and ordinances, This set of approved plans must be kept on the
jobsite until completion.