PMT17-00254 City of Menifee Permit No.: PMT17-00254
29714 HAUN RD. Type: Residential Plumbing
'JICCEL:� MENIFEE, CA 92586
MENIFEE Date Issued: 01/27/2017
PERMIT
Site Address: 25622 ROANOKE RD, MENIFEE,CA Parcel Number: 339-042-024
92586 Construction Cost: $2,000.00
Existing Use: Proposed Use:
Description of REPLACE 40 GAL GAS WATER HEATER IN LAUNDRY ROOM
Work:
Owner Contractor
MONTY HUFFINE A R S AMERICAN RESIDENTIAL SERVICES OF
25622 ROANOKE RD 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 OQt t Amount 1$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
$115.16
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specificalions 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_Pernit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the pmjects
1 herebyaffirm 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 D I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Cl Qs- ✓ License No Bymy signature below 1 acknowledge that,except for my personal residence
Expires Ht Signature tlin which l must have resided for at least one year priorto completion of
1-11 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
❑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 workers 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 wwwJeainfo.a.Rov/calaw.html.
this permit Is issued.
Policy#
Date
r7Lhave and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
Section 3700 of the Labor Code,for the performance of the work for which D�f mysOrrgnature below l certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy wb ner authorized to act on the property owners behalf.I have read this
number are application and the information I have provided is correct.I agree to comply
` with all applicable city and coun nances and state laws relating to
Carrier ��AA building c stru .I auth representatives of this city or county to
Polfcy# - (�fJ Expires enter th dentifi erty forinspection purposes.
(This section need not to be completed is the permit is f tune-hundred Date 1 y
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
�ertify,that in the performance of the work for which this permit is issued,
Ishailnotemolov anyperso in any mannerso to become subject to the CITY BUSINESS LICENSE#
workers compensation 5ulCf nfa,a ree that if l should become HAZARDOUS MATERIAL DECLARATION
Subject to the work s comy�ton "tuns of5ection 3700 ofth Labor
Code,Ishall fo ith xfipl -wit rov'ions. / Will the applicant or future building occupant handle hazardous material ora
Applicant `/ Date S �f mixture containing a hazardous material equal to or greater that the
1. amounts spe fled on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATIO COVERAGE IS o Yes No
UNLAWFUL,AND SHALLSUB3ECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building bythe 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 37060F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY o Yes -d-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) o Yes Flo
OWNER BUILDER DECLARATIONS I have read the Hazardou aterial Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that lam exempt from the permitting checklist. nder my require under the State of
Contactors License Law for the reason(s)indicated below by the California Healt Saf de,Section and 25534 concerning
hazardous erica rting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Yes
Business and Professions Code).Any city or county that requires a permit to 5Date
construct,alter,improve,demolish or repair any structure,prior to its ROPERTY OWNER OR AUTHORIZEDAGEp1T
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 Contactors State EPA RENOVATION,REPAIR AND PAINTING(RRPf
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contactors
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 Appliantfor 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
D 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.eya.gov/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 Contractors 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:
D 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
& SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE 7 - PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL ,[RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION []ELECTRICAL ❑MECHANICAL
❑NEW gPLUMBIN/G ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK e(CL `l//0 5,11ilds 6U h Ih IAvn ply r= M
PROJECT ADDRESS pq (Oaz 12OAVN P-)
ASSESSOR'S PARCEL NUMBER w 04agN LOT TRACT
OWNERNAME AOUih OJP Vl(
ADDRESS PSL9 a)- avw ) miPfC
PHONE l Sj lab DOW EMAIL
APPLICANT NAME AVJrG, &aff tv,
ADDRESS b c-411
q
PHONE `S1 .3qf EMAIL
CONTRACTOR'S NAME OWNERBUILDER? ❑YESffNO
BUSINESS NAME QSWe- u44f IA S ff
ADDRESS 5 -v deft, S k (VO P i - - C A 4
GI
PHONE `S1 3,-jj q'S� I EMAIL
CONTRACTOR'S STATE LIC NUMBER -7(oS fSs LICENSE CLASSIFICATION C3(t7
VALUATION L SO FT
APPLICANT'S SIGNATURE —_ DATE / 'a 7-1
DEPARTMENT DISTRIBUTION n CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAIDAMOUNT
AMOUNT05• OCASH OCHECK# OCREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD 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 951-672-6777
www.cityo fineni fee.us Inspection Request Line 951-246-6213
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