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PMT17-00075
City of Menifee Permit No.: PMT17-00075 29714 HAUN RD. Type: Residential Plumbing <ACCELA-? MENIFEE, CA 92586 MENIFEE Date Issued: 0111 2/2 01 7 PERMIT Site Address: 26126 GOLDENWOOD ST, MENIFEE, CA Parcel Number: 335-424-013 92586 Construction Cost: $2,786.37 Existing Use: Proposed Use: Description of REPLACE EXISTING 50 GAL WATER HEATER Work: Owner Contractor LYNN TAMBLYN A R S AMERICAN RESIDENTIAL SERVICES OF 26126 GOLDENWOOD STREET CALIFORNIA INC MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201 Applicant Phone:9512769744 KENNY PEERY License Number.765074 A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORND 965 RIDGE LAKE BLVD SUITE 201 MEMPHIS, CA 38120 Fee Description Qtv Amount IS) 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 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_Bldg_Permit_Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of DNision 3 of the Business and ❑I am 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 Clasr Elg l C�0l License No.'7 6 5 0 / + / �— By my signature below l acknowledge that,except for my personal residence Expires- t ignature sl: e nn.0 in which I must have resided for at least one year prior to completion of WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I have built as an owner-builder!fit has not been constructed In Its entirety by j.1 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 performance orwork for which vnvw.leeinfo.ca.eov/calaw.h[ml. this permit is issued. Policy If Date .*have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT [section 3700 of the Labor Code,for the performance of the work for which O By my signature below l certify to each of the following:I am the property this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this number are: application and the information I have provided is correct I agree to comply Carrier �)�fo7e1�1 with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city orcounty to POIlcy#7Q5Y0& Rbj!/ Expires 6 — 2,0 j7 enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT °Icertify that in the performance of the work for which this permit is issued, © 2 �0�� I shall not employ any persons In any manner so as to become subject to the CITY BUSINESS LICENSE# 3 worker's compensation laws of California,and agree that if I should become ZARDOUS MATERIAL DECLARATION subject to the worker's compensation provisions of Section 3700 of the Labor code,I shall forthw'th comply with those provisions. !II the applicant or future building occupant handle hazardous material or a A licant Date, [-- 1�-17 , mixture containing a hazardous material equal to or greater that the Pp amounts specified on the Hazardous Materials Information Guide? WARNING:FARJURETO SOCREWORI, COMPENSATIONCOVERAGEIS Oyes A11E, UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($SDoo00),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 37060F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines CONSTRUCTION LENDING AGENCY OYes Pir 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 Cade) OYes D� OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt From the permitting checklist I understand my requirements under the State of California Contractor hazardous s License Law for the reasan(s)indicated below by the Health al Safety Cade,Section 25505 and 25534 concerning rdo checkmark(s)I have placed next to the applicable item(s)(Section 70315 hus material reporting. ^ Business and Professions Code).Any city or county that requires a permit to OY ONoee Date construct,alter,improve,demolish or repair any structure,prior to its - �Zn 1 ! issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR OR11ED ED AGERRr' that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION.REPAIRAND P1 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 ofSectloq 7031.5 by residence or childcare facility to be RRP-certlfied firms and comply with an Applicant for a permit subjects the applicant to a civil penaltyof not more required practices.This includes rental property owners and property than($500). managers who do the paint-disturbing work themselves or through their O1,as owner of the 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.epamov/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 Contractor's State License Law does not apply to an owner of a OAn 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. ❑No EPA Lead-Safe Certified Firm is required for this project because: ❑1,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors 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 TYPE: ❑COMMERCIAL ZRIESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL ❑NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK < 1q C73 717 PROJECTADDRESS 4 7� �RRpp ASSESSOR'S PARCEL NUMBER 335-LGl.(- 013 LOT CT[yofM9111tee PROPERTY OWNER'S NAME Building & Safety Dept. ADDRESS Q // �� JAN 12 PHONE /�/ /I2- 181D EMAIL APPLICANT NAME /Ll rVP' ADDRESS c3D�b f�'�S �� lU E/�I�� C,4 PHONE Ca6) kloo 7- EMAIL CONTRACTOR'S NAME / v( /livlC OWNERBUILDER7 ❑YESLNO BUSINESS NAME ADDRESS .�1 PHONE ( ay ) L(/(OQ��(��-� EMAIL CONTRACTOR'S STATE LIICCNUMBER a �7 LICENSE CLASSIFICATION C70 CZ4, C, VALUATION$ ^/ d6•3 SQ FT Iq L SO FT/ APPLICANT'S SIGNATURE .1L4L,LL/ DATE / ��-�� /7-7 DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP INVOICE �! { PAIDAMOUNT O AMOUNT I15.\ J .1S CASH 0CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building& Safety Department 29714 Haun Rd. Menifee, CA 92586 951-572-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 ` E m o .q 12 Ic P = a d p' m `a O w o O .3 o y u w a apt. m c �+ v � 3 E o ` m a Q m o !2 s Op Oa " m �'F �C N m v Y 2 O i! c _ " pmp E N m a u m L o � m 3 v ❑ ❑ y « 3 p o r E p' E E ti 0 O a R c m ° L o .i y LL 3 a c E U O JE � m {./ LL' Ua+ -0 C �' Z � d C ,_ � ' u ELLSCm _ y W 1 o q y a 9 N m 42 m m S v c E u N c O OE 0= 0 LU I-- y - C G IC C L = C N Y Q .cC d V c E 3 c 3 E 4' p y t E C FmmmCO r w 02u Ejy o2 k �.i 3 9 C O W N y N L C L d N m - C E d E a+ W C E ° c c 3 o r +, a —v1p o c N m m E a; N 0 W O c .c d e a .Itl +• a +, m v r m F Z M O 1- y `m m c n c o c E E �° rm a v p Y M ' J C CJ Y Z m W C W N L y C Y Y m N d cx = e D W 2 U -O O N N m 4W Z C m rIt a F c pO m t d n .QxW L3 « mO mm E m ei s c R E' r c E m u x ❑ o A N ro� mncoE z cdmuHc 3 y i� Zw W d W i N m Q m mwwv V o. C'J S' $ `o .01c m N Z c C a y o J W N t; c v N — Q o m a J N 10 c m a V ? 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