PMT17-00253 City of Menifee Permit No.: PMT17-00253
29714 HAUN RD, Type: Residential Plumbing
4l-CCEL/? MENIFEE, CA 92586
MENIFEE Date Issued:
01/2712017
PERMIT
Site Address: 27730 BARON RD, MENIFEE,CA 92565 Parcel Number: 329-290-038
Construction Cost: $2,100.00
Existing Use: Proposed Use:
Description of REPLACE 50 GAL GAS WATER HEATER IN GARAGE
Work:
Owner Contractor
DOUGLAS DONAHUE A R S AMERICAN RESIDENTIAL SERVICES OF
27730 BARON[RD CALIFORNIA INC
MENIFEE,CA 92585 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9012719700
ANDREW ALLEN License Number:765155
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIU
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS,CA 38120
Fee Description o_yt Amount 151
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_eldg_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 Division 3 of the Business and a I am exempt from licensure underthe Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Cl .l License No
QQ ff By my signature below I acknowledge that,except for my personal residence
Expires NI 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
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
D I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that 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 of work for which www.Iegimfio.ca.gav/caIawhtmI.permit fs issued.
Polity#
Date
rrVLhave and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
Section 3700 of the Labor Cade,for the performance of the work for which 0 fmYmysrgnature below lcertify to each of the following:lam the property
this permit is issued.My worker's compensation insurance carrier and policy w>r ner or authorized to act on the property owner's behalf.1 have read this
number are application and the information I have provided is correct.I agree to comply
Carrier � with all applicable city and coup nances and state laws relating to
building stru Iauth representatives of this city or county to
Policy 4 d Expires enterth denfifi erty for inspection purposes.
(This section need not to be completed Is the permit is flirune-hundred Date
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 persup in any manner scW to become subject to the CITY BUSINESS LICENSE#
workers compensation s of C 1' nia,a ree that if 1 should become HAZARDOUS MATERIAL DECLARATION
subject to the work tOM -n . ions of Section 3700 ofth Labor
Code,lshall fo ith �i wit o rov ions. / Will the applicant or future building occupant handle hazardous material or
Applicant Date 6 cf mixture containing a hazardous material equal to or greater that the
f. amounts spe Pied on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER COVER'S COMPENSATIO AGE IS a Yes 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 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 for guidelines
CONSTRUCTION LENDING AGENCY D Yes -tT`6O
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) o Yes 14010
OWNER BUILDER DECLARATIONS I have read the Hazardou atemal Information Guide and the SCAQMD
I hereby affirm under penalty of perjurythat I am exemptfrom the permitting checklist. nde my require underthe State of
California Healt 5af de,Section and 25534 concerning
Contractors License Law for the reason(s)indicated below by the ;ROPERTY
zardous eria rting.
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 es o /J f
Business and Professions Code).Any city or county that requires a permit to Date L L
construct,alter,improve,demolish or repair any structure,prior to its 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 IRRP)
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 RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves orthrough their
o I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eoa_g_ov/lead/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800.424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a D An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement Is sold within one year of Firm Certification No:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. D No EPA Lead-Safe Certified Firm is required for this project because:
a 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a if your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
& SAFETY PERMIT/PLAN CHECK APPLICATION
- Menifee
DATE 1-7 PERMIT/PLAN CHECK NUMBER 17�Wa
TYPE: []COMMERCIAL ORESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA [-]SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL [-]MECHANICAL
❑NEW ErPLUMBING [-IRE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Q -150 onl6a c W q f'
PROJECTADDRESS �1 Q L�Ifll 1Q' 1
ASSESSOR'S PARCEL NUMBER JV LOT q TRACT
OWNER NAME OLD Po�n hoe
ADDRESS 561ync �5 +L
PHONE qG1 R9 5$ `�, I EMAIL
APPLICANT NAME
ADDRESS 41 v
PHONE 4)51 I ';ryj1( EMAIL
CONTRACTOR'S NAME OWNERBUILDER? [-]YESktNO
BUSINESS NAME gesc&4
ADDRESS 15olb vJ rt Q y-C
PHONE 951 3N 1 L9 y7 I EMAIL tt�� I
CONTRACTOR'S STATE LIC NUMBER _ � LICENSE CLASSIFICATION GJ(e
VALUATION$ 1 vv C. L SQ FT
APPLICANT'S SIGNATURE DATE I-7
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE 11
/ PAIDAMOUNT
AMOUNT 5• J 1 O CASH O CHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OC65H 0 CHECK# 0CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92596 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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