PMT16-04354 City of Menifee Permit No.: PMT16-04354
29714 HAUN RD. Type: Residential Plumbing
<A—CCIELA—> MENIFEE, CA 92586
MENIFEE Date Issued: 12/22/2016
P E R M I T
Site Address: 26256 FAIRLANE DR, MENIFEE, CA Parcel Number: 335-163-007
92586 Construction Cost: $1.700.00
Existing Use: Proposed Use:
Description of REPLACE 40 GAL ELECTRIC WATER HEATER, SAME LOCATION
Work;
Owner Contractor
HUEY HISEL A R S AMERICAN RESIDENTIAL SERVICES OF
26256 FAIRLANE DRIVE 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 CALIFORNU
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description city Amount($1
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 emors 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 Wthin 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.Bidg_Permit-Template.pt Page 1 of I
CITY OF MENIFEE
LICENSED DECLARATION property who builds or Improves;thereon,and who contracts for the priijects
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!)(commencing with section 7000)of Division 3 of the Business and o I a in exem pt from Ikensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason-
s n 0
.36 By my signature below I acknowledge that,except for my personal residence
License Cl Ucen:eaN,
Expi Signature. in which I must have resided for at least one year priorto completion of
improvements covered by this 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 OfSElf-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 th is Labor Code,for the performance of work for which www.leRinfo.ca.Roy/calaw.htmI
this permit is Issued.
Policy It PROPERTY OWNER OR AUTHORIZED AGENT Date
�'Lhave and will maintain worker's compensation insurance,as required by
tection 3700 of the Labor Code,for the performance of the work for which n my signature below I certify to each of the following:I am the property
""my
this permit is issued.My worker's compensation insurance carrier and policy enr or authorized to act on the property owner's behalE I have read this
numberarej,& _6 application and the Information I have provided Is correct.I agree to comply
inances and state laws relating to
with all applicable city and coun"'P915.1
Carrier building c stru tro?.I auth J representatives of this city or county to
Policy# d JG I I Expires. (bit I fir enterth entift arty for inspection purposes.
(This Section need not to be completed is the permit is&olne-hundred 9f!�* Dab
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
ertify that in the performance of the work for which this permit is issued,
I shall not employ any persopm any manner sW to become subject to the CITY BUSINESS LICENSE#
worker's crimper [on of 5ollWhia,3 W,4ree that if I should become HAZARDOUS MATERIAL DECLARATION
subjecttothew( �10�Mmsl;'� szo ec um 0
wit�io ivo.n IS 1- 3700 1 th Labor
Code,I shall fortO I ns�- Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
mt� Date amountlVe.-fied an the Hazardous Materials Information Guide?
S TIO CO N
WARNING:FAILURETO SECURE WORKER'S COMPEN A 0 Yes
UNLAWFUL,AND SHALL SUBJECr AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicza nt or futu re build ing
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 permitting checklist
IN SECUON 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for gundelln s
CONSTRUCHON LENDING AGENCY 0 Yes =No
I hereby affirm that under the penalty 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 f1c]'6NO
OWNER BUILDER DECLARATIONS I have read the Hazardo"aterial Information Guide and the SCAQM D
permitting checklist. riders in require
California Healt Sat rs Xi�under the State of
'ist
I hereby affirm under penalty of perjury that I am exempt from the de,5,ction and 25534 concerning
icense Law for the reason(s)indicated below by the zar ous eria 5f, rting.
rt g_
Ir ' d
Contractor's U a, er in
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 2 50 _
Business and Professions Code).Any city or county that requires a permit to '0 es a Ao , i�_2 Date JO
construct,alter,improve,demolish or repair any structure,prior to its �RDPE NER 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(FIRM
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
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be R119-certiffled finins and comply With
an Applica nt 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 or through their
a 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( I portion of the work,and the structure is winivi.epa.goy/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-809-424-LEAD(5323).
Code,The Contractor's State License Law does not apply to an owner of a o 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. cz No EPA Lead-Safe Certified Firm is required for this project bemuse:
n 1,as owner of the property am exclusively contracting with licensed
contractars 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 E PA R RP ru le please fill o ut the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER anu -OL ej�
TYPE: [-]COMMERCIAL 0'RESIDENTIAL [-]MULTI-FAMILY [:]MOBILEHOME [:]POOL/SPA E]SIGN
SUBTYPE: F]ADDITION []ALTERATION F]DEMOLITION [:]ELECTRICAL [-]MECHANICAL
F]NEW E]PLUMBING [:IRE-ROOF-NUMBEROF.SCXUARES
DESCRIPTION OF WORK _R"Velfe- hexle,-
PROJECTADDRESS hill-kne Dl- OQ%ko
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
F4irl4ne 5on el& L14 %2JS(o
ADDRESS &,I kt
PHONE &ISI 6 72 7379 EMAIL
APPLICANT NAME A v�A f-\I
ADDRESS 5ame 6� ( 0
PHONE q,��) e�H) EMAIL
CONTRACTOR'S NAME —A425(,L)e OWNERBUILDER? [_]YES21i6
BUSINESS NAME
ADDRESS 15�() vj Lllvlder� Ve f;Je- (,A
PHONE 9,51 �H I q5-11 EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
A ATION 1700 LSQ FT
APPLICANT'S SIGNATURE DATE 2 ) 2AI(
ldmat� AwlL- -i9W
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
RUIIDlNr PLANNING ENGINEERING FIRE I GREEN SMIP � )e
INVOICE PAIDAMOUNT
AMOUNT HECK 4 OCREDITCARD VISA/MC
1 0 CASH 0 C
PLAN CHECK FEES PAIDAMOUNT C)CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DLINIUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityoftnenifee.us Inspection Request Line 951-246-6213
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