PMT16-04023 City of Menifee Permit No.: PMT16-04023
29714 HAUN RD. Type: Residential Plumbing
-(�kCCEL;�> MENIFEE, CA 92586
C-1111 Wt.— MENIFEE Date Issued: 1210912016
P E R M I T
Site Address: 31159 BELL MOUNTAIN RD, MENIFEE, Parcel Number: 372-263-011
CA 92584 Construction Cost: $2,63&00
Existing Use: Proposed Use:
DescrIption of 50 GAL GAS WATER HEATER REPLACEMENT, LOCATED IN GARAGE
Work:
Owner Contractor
SARORM KHOUT A R S AMERICAN RESIDENTIAL SERVICES OF
31159 BELL MOUNTAIN RD CALIFORNIA INC
MENIFEE, CA 92584 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9012719700
ANDREW ALLEN License Number:765155
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORN]i
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description QtV Amount
Residential Water Heater 1 8100
Building Permit Issuance 27.00
GREEN FEE 1.00
General Plan Maintenance Fee-Plumbing 1 4.15
$115.16
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of effors 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_B1dg_Perrnit Ternplate.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improvesthereon,and who contracts forthe projects
I herebyaffirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuantio the ContractiosState License Law).
Chapterg(commencing with section 7000)of Division 3 of the Business and ti I am exempt from licensors under the Contractor's State Viceme Law for
Professions Code and my license Is in full force and effect the following reason:
License License No By my signature below I acknowledge that,"cept formy personal residence
Expires Signature In which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKE �RATION have built as an owner-builder If It has not been constructed in its entirety by
o I hereby affirm under pens Ity 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 Professions Code,is avallable 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.leginfa.m.govIcalaw.hliml.
policy 0 Date
,�Lhave and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
hection 3700 of the Labor Code,for the performance of thework farwhich 0"'my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy 15ovirm,or authorized to act an the property owner's behalf.I have read this
numberarel'& application and the information I have provided is courect.I agree to comply
with all applicable city and counv?ornances and state laws relating to
Carrier bWuildinScstru pn...i authp!0fereproentatives;of this city or county to
POlicV#JJ(5J('Sd%Jt Expires (b ft e de III erty for inspection purposes.
(This section need not to be completed is the permit is&'Ile-hundred Date 14
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
certify that in the performance of the work for which this permit is Issued,
Ishallnotemplo any persopin any manner.sW to become subject to the CITY BUSINESS LICENSE#
worker'scompens ;,n HAZARDOUS MATERIAL DECLARATION
V_�5 of 9al!o7nia,3p�,r4rerz that if I should become
subject to the war coarn soas e on 0 7 a 0
,,,�lo ,i'o.n f S ct 3700 f th L b
a
Code,I shall lo 9 h �'�i . . /I Will the applicant or future building occupant handle hazardous material or a
VIA,, mixture containing a hazardous material equal to argreater that the
Applic;1 Nf amounts spe 'Red on the Hazardous Materials Information Guide?
D
U 0
WARNINGi FAILURE TO SECURE WORKER'S COMPENSATI COVERAGE IS t Zo
UNLAWFUL,AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENAL11ES Wilitheintencled use of the building by the applicant or future building
ANDCIVILFINES UP TOONE HUNDRED THOUSAND DOLLARS($3.00,000),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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidellnes
CONSTRUCTION LENDING AGENCY n Yes -ty-N-0
I hereby affirm that under the pens Ity of perjury there is a construction Will the proposed building or modifted facility be m(ithin 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) Dyes'/�O
OWNER BUILDER DECLARATIONS I have read the Hazardo"aterial Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checkIist_,ld-nder4X8my require underthe State of
California Healt Saf de,Section and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazarcl me.
checkmark(s)I have placed next to the applicable ftern(s)(Section 7031.5 'dy�s'di�p
Business and Professions Code).Any cityor county that requires a permitlo :;-5 Date
construct,alter,improve,demolish or repair any structure,prior to its ZROPERTY OWNER 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(RRPI
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 licensure receiving compensation for most work that disturbs paint in a pre-1978
a nd the basis for the alleged exemption.Any violation Of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
a n 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 themselveror through their
o 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,wilil do( )all of or I )portion of the work,and the structure is www.epa.gay/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Buadness and Professions 1-800-424-LEAD(5323).
Code,The Contractor's State License Law does not apply to an owner of a rt 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 Certificatilon No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. cr No EPA Lead-Safe Certified Firm Is required for this project bemuse:
ci 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's 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.
& SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: F-ICOMMERCIAL DRESIDENTIAL Ej MULTI-FAMILY E]MOBILEHOME OPOOL/SPA [-]SIGN
SUBTYPE: []ADDITION []ALTERATION []DEMOUTION E]ELECTRICAL [-]MECHANICAL
E]NEW []PLUMBING El RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 4� IJ17
PROJECTADDRESS �?Izjc—f W&Kke"',
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNERNAME el jou Sa ro r vy, +
*1 4z-
ADDRESS
PHONE 4/1 971' �M EMAIL
APPLICANT NAME lqjo X*
ADDRESS 'Jow a,6
PHONE ?fl3yl�j 71 EMAIL
CONTRACTOWS NAME R6/,5C-L)C- 40/ep- OWNER BUILDER? E]YES-DNO
BUSINESS NAME
ADDRESS I�JO �J Zfil,& Sol- kjltfl!�lh
PHONE e-?5-7 5f F)71 EMAIL
— -S.'
CONTRACTOR'S STATE LIC NUMBER 7�95 f5 LICENSE CLASSIFICATION L
VALUATION$ S LSQFT
- 7 DATE
APPLICANT'S SIGNATURE
�2�'G -
71CI;7STA�FF 6;E ONLY"�r,�Ada000lr
DEPARTMENT DISTRIBUTION SMIP CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE I PAIDAMOUNT
AMOUNT I tro -I C-7 1 1 OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES I PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LE17ER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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