PMT16-04025 City of Menifee Permit No. PMT16-04025
29714 HAUN RD. Type: Residential Plumbing
<A-CCELA-> MENIFEE. CA 92586
MENIFEE Date Issued: 12/09/2016
PERMIT
Site Address: 28231 WINGED FOOT DR, MENIFEE, CA Parcel Number: 337-251-004
92586 Construction Cost: $2,450.00
Existing Use: Proposed Use:
Description of REPLACE 40 GAL GAS WATER HEATER, LOCATED IN INTERIOR CLOSET
Work:
Omer Contractor
JOHN MCCALLEY A R S AMERICAN RESIDENTIAL SERVICES OF
28231 WINGED FOOT DR CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9012719700
ANDREW ALLEN License Number:765155
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORND
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
specifications or from preventing building 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-Template.rpt 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).
Chapter!)(commenciing with section 7000)of Division 3 of the Business and o I am exempt from licenst[Te under the Contractor's State License Law for
Professions Code and my license Is in full force a d effect the following reason:
Licens License N9 By my signature below I acknowledge that exceptfoirmy personal residence
Expire: Signature inwhichl must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legallysell a structurethatl
WORM ARATION have built as an owner-builder if it has not been constrincted in its entirety by
cz I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applica ble law,Section
have and will maintain a certificate of consent ofself-Insure for worker's 7044 ofthe 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 performance of work for which
this permit is issued. www.leginto.m.goylulaw.littril.
policy# Date
'�`have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
bection 3700 of the La bor Code,for the performance of the work for which a ignature below I certify to each ofthe following:I a in the property
this permit is issued.My worker's compensation insurance a rrier and policy e'"'.'mr Yosauthorized to act on the property owner's behalf.I have read this
numberairel,,� _6 �VC applimitilon and the information I have provided is correct.I agree to comply
with all applicable city and coun"Orhances and state laws relating to
Carrier buildingco stru trog.1 aut��representatives oftli city or county to
Policv#IJ(;16S dtf)JI Expires (b IN 'nterth rty for inspection purposes.. I
(This section need not to be completed is the permit is At-u.-hundred 7�7 Date—
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
1�certify that in the performance ofthe work for which this permit Is issued,
I shall not emolay Y .na y zzzannens�p to become subject to the CITY BUSINESS LICENSE#
worker's compen ation s ofC H his,a ree that if I shoul ecome HAZARDOUS MATERIAL DECLARATION
subject to the wo com ion . tons ofSection 3700 oft7hLabor
Code,I shall to Ith it rov ion Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or grater thatthe
Applicant amount�ssp"effiiecl on the Hazardous Materials Information Guide?
COVERAGE IS C No
WARNING;FAILURE TO SECURE No
UNLAWFUL,AND SHALLSUBJECrAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use ofthe building bythe applicant orfuture building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),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 a Yes -6-6`0
I hereby affirm that under the penalty ofperjury there is a construction Will the proposed building or modified facility be Within 1000 feet ofthe
lending agency for the performance ofthe work which this permit is issued outer boundary ofa school?
(Section 3097 Civil Code) a Yes 1-il'KNO
OWNER BUILDER DECLARATIONS I have read the Hazardo"aterial Information Guldeand the SCAQMD
r P-91
nde I my requlrejp�gnunder the State of
permitting checklist
I hereby affirm under penalty of penjury that I am exempt from the California Heait Sa de,Section and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous edia rting.
checkmark(s)I have placed next to the applicable item(s)(Section 703LS Yes 0
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its OF TYOWN UT ORI
issuance,also req uires the applicant for the permit to file a signed statement ;.ROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRPl
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 compenlatilDn for most work that disturbs paint in a pre-1978
a nd the basis for the alleged exemption.Any violation ofSection 7032.5 by residence or childcare ficility to be RRP-certlfied firms and comply with
an Applicant for a permit subjects the applica nt 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 orthrough their
cz 1,as owner ofthe property,or my employee with wages as theirsole 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.gay/lead or contact the National Lead Informarlon Center at
not intended or offered for sale.(Section 7044,Busmess and Professions 1-800-424-LEAD(5323).
Code;The contractoes 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. cr No EPA Lead-Safe Certified Firm is required forthis project bemuse:
cz 1,as owner ofthe 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 Ifyour project does not comply With EPA RRP role please fill out the RRP
Acknowledgement.
& SAFETY PERMIT/PLAN CHECK APPLICATION
6�C
"Wenifee
DATE Id PERMIT/PLAN CHECK NUMBER
TYPE: F-ICOMMERCIAL [3AESIDENTIAL [-]MULTI-FAMILY E]MOBILEHOME [-]POOL/SPA [-]SIGN
SUBTYPE: E]ADDITION []ALTERATION E]DEMOUTION F]ELEcTRICAL EIMECHANICAL
[:]NEW F]PLUMBING [-IRE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK f4-111ov' OA�
0 ,V,�
PROJECTADDRESS ej ao�-
ASSESSOR'S PARCEL NUMBER -5�5—r--A%-10�LOT C6 TRACT
OWNERNAME
ADDRESS '4A OA,� a b
PHONE '7V C9 � 5Z S-6 EMAIL
APPLICANTNAME Affni
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME �CScoe- fto(�-kr (z 5 OWNERBUILDER? [:IYESf�O
BUSINESS NAME
ADDRESS 157�-o vo LvJe�- sl- cr qd5--"7
PHONE Ylko(3-1 \ EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION c C
VALUATION$ ��& LSQ FT
APPLICANT'S SIGNATURE DATE
7CWS�AF;U7E'ONLY`
DEPARTMENT U15TRIBUTIUN SMIP JA--71TY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE 111 PAIDAMOUNT
AMOUNT I 1 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT I 1 0 CASH 0 CHECK# 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.cityoftnenifee.us insperrion Request Line 951-246-6213
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