PMT17-00436 City of Menifee Permit No.: PMT17-00436
29714 HAUN RD. Type: Residential Plumbing
�/-�CCELI> MENIFEE, CA 92586
MENIFEE Date Issued:
02/14/2017
PERMIT
Site Address: 26340 BRADSHAW DR, MENIFEE, CA Parcel Number: 331-473-028
92585 Construction Cost: $1,600.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 40 GAL WATER HEATER IN GARAGE
Work:
Owner Contractor
GRACE WEED A R S AMERICAN RESIDENTIAL SERVICES OF
26340 BRADSHAW DRIVE CALIFORNIA INC
MENIFEE,CA 92585 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9012719700
ANDREW ALLEN License Number: 765155
A R S INC DBA RESCUE ROOTER
1520 W LINDEN ST
RIVERSIDE, CA 92507
Fee Description Oft Amount($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
$115.15
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 buillding 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 penult 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 projects
With a licensed contractors)pursuant to the Contractors State License Law).
1 herehyaffirm 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 Cade and my license is in full force and effect the following reason:
License CI s— 3 License No J
qq By my signature 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 mnnot 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
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 w„ww.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy# Date
,7crLhave and will maintain workers compensation insurance,as required by PROPERTY OWNER ORAUTHORIZED AGENT
Section 3700 of the Labor Code,for the performance of the work forwhich D my signature below I certify to each of the following:)am the property
this permit is Issued.My workers compensation insurance carrier and policy wner or 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 ��g building co stru Iauth representatives of this city or county to
Policy# a Expires enter th dentifi erty for inspection purposes.
(This section need not to be completed is the permit is f1irone-hundred ^ �(,
Date
dollars($100)or less
PROPERTY OWNER OR AUTHORIZED AGENT
7ertify that in the performance of the work for which this permit is Issued,
I shall not emol.vany pers. in Eon
tobecome subject to the CITY BUSINESS LICENSE#
workers compensation s of C 1' nla,a ree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the work com �ion ' ions of5ection 3700 ofth Labor
Code,Ishall fo fth rfi ,wit rov ions. / Will the applicant or future building occupant handle hazardous material or
Applicant Date S �.{ mixture containing a hazardous material equal to or greater that the
amounts spe Fed on the Hazardous Materials Information Guide?
lov
WARNING:FAILURE TO SECURE WORKER'S COMPENSATIO COVERAGE IS ❑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($300,000),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 forgufdelines
CONSTRUCTION LENDING AGENCY ❑Yes -fl 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 Cwil Code) D Yes 11""No
OWNER BUILDER DECLARATIONS I have read the Hazardou aterial Information Guide and the SfAQMD
permitting checklist. nder a my require underthe State of
I hereby affirm under penalty of perjury that I am exempt from the California Heals Safe de,Section and 25539 concerning
Contractors License Law for the reason(s)indicated below by the hazardous eda rtIng.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 �� 0
Business and Professions Code).Any city or county that requires a permit to Date S
construct,after,improve,demolish or repair any structure,prior to its ROPERTYOWNER 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 Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRP)
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 or through 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.epa.goy/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 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. ❑No EPA Lead-Safe Certified Firm is required for this project bemuse:
D I,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.
Y
& SAFETY PERMIT/PLAN CHECK APPLICATION A-
�3csJ
Menifee
DATE - LA- PERMIT/PLAN CHECK NUMBER Q 3
TYPE: [:]COMMERCIAL RESIDENTIAL [I MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑NEW ,❑'PCUMBING ❑RE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK L one Q' I►� 4 r e
PROJECTADDRESS r 2I h� l/OvBJ
ASSESSOR'S PARCEL NUMBER 331-j4aj .ba-CA LOT TRACT
OWNER NAME
ADDRESS g HqW Dr Bulldtng & Safety DIS
ept.
PHONE q-il 301 oa03 EMAIL FEB 14 2017
APPLICANT NAME d1-w cr
ADDRESS ISw L rdz� Is 9(w5idt
PHONE 4,57 3y( 937( EMAIL
CONTRACTOR'S NAME OWNERBUILDER7 [:IYES_DNO
BUSINESS NAME Q O W�7
ADDRESS �U"� W (� si f'7 m 4 � 69 D/
PHONE 9'S'( �j2f f Cj'3'f EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSEE . IFICATION G34o
VALUATION$ - /� L SO FT APPLICANT'S SIGNATURE ` � DATE -l7
DEPARTMENT DISTRIBUTION CIN OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP k
INVOICE
AMOUNT • PAID AMOUNT I,5 . 1FJ OCASH OCHECKN 0CREDIT CARD VISA/MC
HP
N CHECK FEES PAIDAMOUNT 0CASH 0CHECK# 0CREDIT CARD VISA/MC
UILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Deportment 29714 Haun Rd. Menifee, CA 92586 951-672-5777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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