PMT17-00661 City of Menifee Permit No.: PMT17-00661
29714 HAUN RD. Type: Residential Plumbing
<ACCF1/-> MENIFEE, CA92586
MENIFEE Date Issued: 03/02/2017
PERMIT
Site Address: 28300 LONG MEADOW DR, MENIFEE, Parcel Number: 340-292-004
CA 92584 Construction Cost: $1,890.00
Existing Use: Proposed Use:
Description of REPLACE 50 GAL GAS WATER HEATER IN GARAGE
Work:
Owner Contractor
JACK DAVIDSON A R S AMERICAN RESIDENTIAL SERVICES OF
28300 LONG MEADOW DRIVE CALIFORNIA INC
MENIFEE,CA 92584 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9012719700
ANDREW ALLEN License Number:765155
A R S INC DBA RESCUE ROOTER
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description ON 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
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 contactor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o 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 Cl s ✓ License No J�
qq By my signature below I acknowledge that,except far 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 1
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 www.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy It Date
PROPERTY OWNER OR AUTHORIZED AGENT
have and will maintain workers compensation insurance,as required by
ection 3700 of the Labor Code,forthe performance of the work forwhich o my signature below I certify to each of the following:l am the property
this permit is issued.My workers compensation insurance carrier and policy caner 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
Carrier 'r with all applicable city and coun mantes and state laws relating to
�AAt building co stru tra Iauth representatives of this city or county to
Policy# �$V Expires enterth dentifi erty for inspection purposes.
(This section need not to be completed is the permit Isf role-hundred Date �4
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
ertify that in the performance of the work for which this permit is issued,
1 shall not employ any perso in any manner so to become subject to the CRY BUSINESS LICENSE#
workers compensation s of C 1" nia,a ree that if i should become HAZARDOUS MATERIAL DECLARATION
subject to the work s corn ion "ions of5ection 3700 ofth Labor
Code,Ishall fo ith wit rov'ions. / Will the applicant or future building occupant handle hazardous material or
Applicant Date 6 Lf mixture containing a hazardous material equal to or greater that the
amounts spe Pied on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATIO COVERAGE IS 0 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 forguidelines
CONSTRUCTION LENDING AGENCY 0 Yes -dN'.
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) Dyes/11-1,10
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. Tide my require under the State of
California Healt Safe de,Section and 25534 concerning
Contractors License Law for the reason(s)indicated below by the h/azardous erica rting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 2Tes o /f r
Business and Professions Code).Anycityor countythat requiresa permitto Date 2� L
construct,alter,improve,demolish or repair anystructure,priorto its ROPERTY 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 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 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.epa.aov/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. o No EPA Lead-Safe Certified Firm is required for this project because:
o I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Cade: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 APPLICATION
Menifee
DATE 5 - 2 - /7 PERMIT/PLAN CHECK NUMBERuIty
nifee
TYPE: ❑COMMERCIALEJRESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA OWN & 6' tyDept.
SUBTYPE: []ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL MAR 0 f 2017
❑NEW PLUMBING ❑RE-RROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK �d/(n'r 42 U 11 IH Kf:?tg iReneived
PROJECTADDRESS pc 300 Oh iIC'4j CG"ke vay
ASSESSOR'S PARCEL NUMBER ?}�►Dp"� �� LOT TRACT
OWNER NAME �.1-O e- ` .k a1Y/�Jd:i
ADDRESS /6a*,tC A-3 D bs 11LC
PHONE IOSD ays J>Iy EMAIL
mW
APPLICANT NAME tw lu, II
ADDRESS isao w ,� SJ- aV fd�
PHONE 1 13LII q 371 yy EMAIL
CONTRACTOR'S NAME J�o 4c.— S OWNER BUILDER? ❑YE -
BUSINESS NAME p
ADDRESS //��'�-o yl t ere 7 do I Zm
q PHONE JI 3y���J]� EMAIL
CONTRACTOR'S STATE LIC NUMBER / G $T LICENSE CLASSIFICATION /
VALUATION$ 1,3f 0 FT ,� L SQ FT
APPLICANT'S SIGNATURE /// DATE 31,1117
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT AMOUNT O CASH O CHECK k O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH OCHECK JI 0CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED C YES C NO DL NUMBER NOTARIZED LETTER O YES C NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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