PMT17-00300 City of Menifee Permit No.: PMT17-00300
29714 HAUN RD. Type: Residential Plumbing
<ACCEL/-' MENIFEE, CA92586
MENIFEE Date Issued:
01/31I2017
PERMIT
Site Address: 28009 LEMONWOOD DR, MENIFEE,CA Parcel Number: 340-065-010
92584 Construction Cost: $1,900.00
Existing Use: Proposed Use:
Description of 50 GAL GAS WATER HEATER CHANGE OUT, LOCATED IN GARAGE
Work:
Owner Contractor
FRANK IRLANDA A R S AMERICAN RESIDENTIAL SERVICES OF
28009 LEMONWOOD DR CALIFORNIA INC
MENIFEE, CA 92584 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9512769744
CHRISTINA CALHOUN License Number:765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIf
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Qtv Amount l$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
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 Division 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 Class 1 C20 C;Li Lic No. t 1 By mysignature below I acknowledge that,except for my personal residence
Expires ( Signature In which l 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 OE 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 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 www.leeinfo.ca.gov/calaw.hhnl.
this permit Is issued.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
o I have and will maintain worker's compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I certify to each of the following:I am the property
this permit Is issued.My worker's compensation insurance canter 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 L with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# %U'b%54SUS 014 Expires 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, �� uV-7Lf
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE It
worker's compensation laws of California,and agree that If I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's comp lion prov¢ of Section 3700 of the Labor
Code,I shall/ I e 1 ith tho rav' ons. Will the applicant or future building occupant handle hazardous material or a
Applicant to 8 f 8 / mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WAR NIN ILURETO SECURE KER'S COMPENSATION COVE GE IS o Yes-4-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(S100,000),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(SCAQM D)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguldelin"es
CONSTRUCTION LENDING AGENCY D Yes U�trao
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) a Yes A.
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the CalifornI Health&Safe de,S el n 255 nd 25534 concerning
Contractor's License Law for the reasons)indicated below by the haz o s m�7eri re
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 O
Business and Professions Code).Any city or county that requires a permit to Date 18
construct,altar,improve,demolish or repair any structure,prior to its PERTY 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(RRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt from licensure The EPA cam pensation
Repair and Paintingat disturbs
Rule requires contractors
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 or through their
o 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( )portion of the work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 71)44,Business and Professions 1-800-424-LEAD(53Z3).
Code;The Contractor's State License Law does not apply to an owner of 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. o 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 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 RAP
Acknowledgement.
BUILDIN & SAFETY PERMIT/PLAN CHECK APPLICATION
DATE TJ� PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL [-]MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: [—]ADDITION [—]ALTERATION [—]DEMOLITION ❑ELECTRICAL ❑MECHANICAL
[]NEW ❑PLUMBING [:]RE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK SO
PROJECTADDRESS z. 009 yvn WO
ASSESSOR'S PARCEL NUMBER LOTZ TRACT
PROPERTY OWNER'S NAME
ADDRESS
PHONE C95i) 301 -- Sgp� EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME RIGHTIME OWNER BUILDER? ❑YES❑✓NO
BUSINESS NAME
ADDRESS 3030 MYERS ST RIVERSIDE CA.92503
PHONE (800)660-0675 EMAIL
CONTRACTOR'S STATE LIC NUMBER 765074 LICENSE CLASSIFICATION C10,C20,C36
VALUATION$ lokocr SQ SO FT
APPLICANT'S SIG NATURE ATE �
DEPARTMENT DISTRIBUTION ,�^ GG� CITY OF}MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN tf" SMIP �/ -
INVOICE PAIDAMOUNT AMOUNT O O CASH CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH O CHECK A OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Deportment 29714 Hn,un Rd. P.4enifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request tine 951-246-6213
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