PMT16-04024 City of Menifee Permit No. PMT1 6-04024
29714 HAUN RD. Type: Residential Plumbing
<A-ccr=LA-> MENIFEE, CA 92586
MENIFEE Date Issued: 12/09/2016
P E R M I T
Site Address: 31407 HALLWOOD CT, MENIFEE, CA Parcel Number: 372-032-D19
92584 Construction Cost: $1,642.00
Existing Use: Proposed Use:
Description of REPLACE 50 GAL GAS WATER HEATER, LOCATED IN GARAGE
Work:
Owner Contractor
SEAN MARTIN A R S AMERICAN RESIDENTIAL SERVICES OF
31407 HALLWOOD CT 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 CALIFORNI)
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS,CA 38120
Fee Description Qtv Amount
Residential Water Heater 1 83.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 4.15
$115.15
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifimtions or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinanoe of City of Menifee.Exmpt 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 BIc1g_Perrnil-TempIate.rpt Page 1 of I
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 contiactor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and cz I am exempt from licensure under the Contmctoes State Ucense Law for
Professions Code and my license Is in full force and effect. the following reason:
Licensecialss,— .136 License No By my signature below I acknowledge that,except forinypersonal residence
Expires)JE I ri Signature in which I must have resided for at least oneyear prilonto completion of
improvements covered bythis permit.I cannot legallysell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
o 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 Professions 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 peribrinance of work for which
this permit is issued. www.IeRinfiz.ca.Rc,v/caIaw.htmL
Policy If Date
,>Lhave and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
Lection 3700 of the Labor Code,for the performance of the work folwhich ignature below I certify to each of the folloWing:I am the property
0 forty
this permit is Issued.My workees compensation insurance carrier and policy ?wrue, rZthorized to act on the property owner's behalf.I have read this
numberaml,& �V� application and the information I have provided is correct.I agree to comply
'��6
with all applicable city and couniy-iip9rhances and state laws relating to
Carrie, P p' representatives of this city or county to
r
=Y for inspect n purposes.
Policy#13C-,I(,�J 4 1 _Expires a ki
(This section need.notto I be completed Is the permit is fhr o I ne-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
entity that in the performance of the work for which this permit is issued,
.2r,rc
Ishallnotemplo anyperso
�m any mannersW to become subject to the CITY BUSINESS LICENSE#
so, a ree that if I should become
worker's compensation s of�0107-ia'300 HAZARDOUS MATERIAL DECLARATION
f S ct' 3700 f th Lab
in el
subjecttothewok co en s o e ion a
Code,I�shall�folth Ions. Will the applicant or future building occupant handle hazardous materlial or a
ith ce Je mixture containing a hazardous material equal to or greater that the
ant
Ap ant 5- ft� 0 ro, Datesfl�'7/" amounts se0fied on the Hazardous Materials Information Guide?
MLARNING:FAILURE TO SECURE WORKER'S COMPENSAT104COVERAGE IS uYes &No
UNLAWFUL,AND SHALL SUBJECT AN 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($100,000),IN occupant require a permit for the construction or modlilication from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Qua lity Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF TH E LABOR CODE,INTEREST;AND ATTORNEYS FEES far guidelines
CONSTRUCrION LENDING AGENCY 0 Yes -d-Kt,
I hereby affirm that under the pena Ity of perjury there is a construction Will the proposed building or modified 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) 0 Yes 11�No
OWNER BUILDER DECLARATIONS I have read the Hazardo"aterial Information Guide andthe SCAQMD
nd -
permitting ch cklist. at aidinyrequirap
I hereby affirm under penalty of perjury that I am exempt from the ,'Pirl rider the State of
Calftornia He I Sel e,Section and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous ria ing.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 dyes o
Business and Professions Code).Any city or county that requires a permit 10 Date
construct,alter,improve,demolish or repair any structure,prior to its 411OPERTY 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 UIRPI
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
an Applicant for a permit subjects the appliu nt to a civil pena Ity of not mom required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or 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,Will do( I all of or I )portion of the work,and the structure is www.eps.00y/lead 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 Contractorrs State License Law does not apply to an owner of a a 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-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ri No EPA Lead-Safe Certified Firm is required for this project b ecause:
a 1,as owner of the property a to 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Wenifee
DATE PERIVIIT/PLAN CHECK NUMBER I+fl 1(0 0%�K
TYPE: [-]COMMERCIAL-[31ffS-IDENTIAL [-]MULn-FAMILY [-]MOBILEHOME E1POOL/SPA USIGN
SUBTYPE: [-]ADDITION E]ALTERATION [-]DEMOLITION []ELECTRICAL El MECHANICAL
F]NEW [-]PLUMBING [:]RE-ROOF-N UMBER OF SQUARES
DESCRIPTION OF WORK
PROJECT ADDRESS �3N07 �14116,Iedfel—
ASSESSOR'S PARCEL NUMBER -;� a —b;��—OJIILOT 101 Ll TRACT
OWNER NAME fi4a,,1fj,
ADDRESS 51pe—e- loh<lk
PHONE rf 2oo S7,3� EMAIL
APPLICANT NAME AvJau) -
ADDRESS �arw q 5 cot,�-rq C-fi"
PHONE 573qt/fj7/ EMAIL
CONTRACTOR'S NAME je,5 we OWNER BUILDER?
YESQ110
BUSINESS NAME
ADDRESS 15'd C) tv t1ae6, ere
PHONE W 3,1� �3 71 EMAIL
CONTRACTOR'S STATE LIC NUMBER -7(, 57S-��— LICENSE CLASSIFICATION
VALUATION$ L SO FT
APPLICANT'S SIGNATURE DATE
i -'MMM=Mh
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE 1 PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
AMOUNT I I
PLAN CHECK FEES PAIDAMOUNT I I OCASH OCHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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