PMT17-00392 City of Menifee Permit No.: PMT17-00392
29714 HAUN RD. Type: Residential Plumbing
ACCEL/k? MENIFEE,CA 92586
MENIFEE Date Issued: 0211012017
PERMIT
Site Address: 28535 JENNY LN, MENIFEE, CA 92584 Parcel Number: 388-023-005
Construction Cost: $1,935.00
Existing Use: Proposed Use:
Description of REPLACE 50 GAL WATER HEATER IN THE GARAGE
Work:
Owner Contractor
LEE CARSON A R S AMERICAN RESIDENTIAL SERVICES OF
28535 JENNY LANE CALIFORNIA INC
MENIFEE, CA 92584 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9512769744
CHRISTINA CALHOUN License Number: 765074
A R S INC DBA RIGHTIME
3030 MYERS ST
RIVERSIDE, CA 92503
Fee Description gyt Amount l5l
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 carded 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
With a licensed cantmctor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and o 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 Class LID C20 C3<o L- qse�A SO'1 By my signature below l acknowledge that,except for my personal residence
Expires -4 Signature( [/�/ in which I must have resided for at least one year priorto 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 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.eov/calaw.htmL
this permit is issued.
Policy# Date
D I have 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 By my signature below I certify to each of the following:I am the properly
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
numberare: application and the information 1 have provided is correct I agree to comply
— ,, �/ with all applicable city and county ordinances and state laws relating to
Carrier 1 r�-C�a building construction.l authorize representatives of this city or county to
Policy#-RA V'!)MVI 0j ExFires -to 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
o I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compe tion p tuns of coon 3700 of the Labor
Cade,I shall with co th os oldnY Will the applicant or future building occupant handle hazardous material ora
p mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNI . ALLURE TO SECUR ORKER'S COMPENSATION COVERAGE IS D Yes D(4o
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($10D,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 forguidelines
CONSTRUCTION LENDING AGENCY D Yes "o
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 b4lo
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 Health&Safe Cade,Section 25505 25534 concerning
Contractors License Law for the reason(s)indicated below by the haza us terial re ng.
checkmark(s)1 have placed next to the applicable item(s)(Section 7031.5 s 0
Business and Professions Code).Any city or county that requires a permit to Date /"J.
construct,alter,improve,demolish or repair any structure,prior to its R OWNER OR AbTfrORIZED 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 Contractors 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 Rcensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 70315 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
01,as owner of the property,or my employee with wages as their sale 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.eov/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 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. o No EPA Lead-Safe Certified Firm is required for this project because:
01,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 • APPLICATION
Menifee
DATE 2 ID �-I PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW PLUMBING O RE-ROOF-NUMBER OF SQUARES` �{
DESCRIPTION OF WORK cSS S G� �T-�, TuIL
PROJECTADDRESS Z.US" S u-%
ASSESSOR'S PARCEL NUMBER 3$$` 3' W�5 LOT TRACT '1ge
OWNER NAME BU11= &Safety BP
ADDRESS �Gl.v�� q a. a„ k.2 FEB 10 201
PHONE ('710) .3�� ' /3� / EMAIL
APPLICANTNAME ►k1
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES
BUSINESS NAME I-
ADDRESS 3b 30 5� v z CJ 3
PHONE &b 49(06 Q(p 6 ' EMAIL
CONTRACTOR'S STATE LIC NUMBER T&sD I(r LICENSE CLASSIFICATION C10 GZO C344-
VALUATION$ S L SO FT
APPLICANT'S SIGNATURE DATE 70 7
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
AMOUNTINVOICE `5•lob -- CASH AMOUNT O CASH OCHECK# OCREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# v'CREDITCARD VISA/MC
[OWNER BUILDER VERIFIED OYES 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.cityofinenifee.us Inspection Request Line 951-246-6213
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