PMT17-00687 City of Menifee Permit No.: PMT17-00687
29714 HAUN RD.
�ACCELh� MENIFEE,CA 92586 Type: Residential Plumbing
MENIFEE Date Issued:
03/07/2017
PERMIT
Site Address: 25455 SUN CITY BLVD, MENIFEE, CA Parcel Number: 339-211-021
92586 Construction Cost: $1,250.00
Existing Use: Proposed Use:
Description of REPLACE 50 GAL WATER HEATER IN GARAGE
Work:
Owner Contractor
VAUGHN CARRIER A R S AMERICAN RESIDENTIAL SERVICES OF
25455 SUN CITY BLVD CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9012719700
ANDREW ALLEN License Number:765155
A R S INC DBA RESCUE ROOTER
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS,CA 38120
Fee Description D_yt Amount I$)
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 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_Pennit_Template.rpl Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
' I herebyaffirm under penalty of perjury that I am under provisions of
Chapter!)(commencing with section 7000)of Division 3 of the Business and o I am exempt from Iicensure underthe Contractors5tate License Law for
Professions Code and my license is in full force and effect. the following reason:
License CI qqy -36 License No 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 priorto completion of
improvements covered by this 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
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
this permit is issued. www.leeinfo.ca.eov/calaw.html.
Policy if Date
`)aave and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZEDAGENT
fection 3700 of the Labor Code,forthe performance of the work forwhich o mysignature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrierand policy w> r 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 4 / with all applicable city and court nances and state laws relating to
�g bWcstruloath representatives of this city or county to
Policy# " ��Il Expires ifi erty for inspection purposes.
(This section need not to be completed is the permit is f r one-hundred Date / �y
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
�ertify that in the performance of the work forwhich this permit is Issued,
Ishalinotemolov anyperso Inanymannerso to become subject to the CITY BUSINESS LICENSE#
workers compensation s of C I' nia,a gree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the work scom,P�ion ions of Section 3700 ofth Lobar
Code,Ishall fo ith z�i -wit o rov' tons. Will the applicant or future building occupant handle hazardous material or
Applicant Date �.f mixture containing a hazardous material equal to or greater that the
amounts spe fled on the Hazardous Materials Information Guide?
WARNING:FAILURETO SECURE WORKER'S COMPENSATIO COVERAGE IS ❑Yes No
UNLAWFUL,AND SHALL SUBIECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant orfuture building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant requires permit for the construction or modification from South
IN SECION306OFTDITION TO THE TOFCOR CODE,INTEREST,
ADATTOGES AS REYSFEOVIDED FOR Coast Air Quality Management District(SCAQMD)7 See permitting checklist
IN SECTION 37060FTHE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY OYes -d-N.
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 -d-No
OWNER BUILDER DECLARATIONS I have read the Hazardou ateriai Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist. nders a my require underthe State of
Contractor's License Law for the reason(s)indicated below by the California Healt Saf de,Section and 25534 concerning
checkmark(s)i have placed next to the applicable item(s)(Section 7031.5 ,hay}ardous eria Ling.
Business and Professions Code).Any city or county that requires a permit to es
Date
construct,alter,improve,demolish or repair any structure,prior to 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 IRRPI
License Law(Chapter 9(commencing with Section 71100)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 Iicensure receiving compensation for most work that disturbs paint in a pre-197g
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.eoa goyllead/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-B0D-424-LEAD(5323).
Cade,The Contractors State License Law does not apply to an owner of a crAn 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, a No EPA Lead-Safe Certified Firm is required for this project because:
U 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 REP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
I
/lenifee
DATE . 7 /—7 PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL ZRIESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION []ALTERATION []DEMOLITION ❑ELECTRICAL El MECHANICAL
❑NEEW QPLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK /,Jrz I/
Q,ct le/ IF) 4 d 4 nif
,., g Safety Deft•
PROJECTADDRESS /j�{ Vn CY ,E7 ✓�- "Wti�0.! ESUIIdin9
ASSESSOR'S PARCEL NUMBER JAq- LOT TRACT MAR 0 7 2 17
OWNER NAME Ui� (J
ADDRESS a yS L.) n Cetx /v�•
PHONE (p 312 d 7/0 EMAIL
APPLICANT NAME rn-i Allen
ADDRESS 5a o GJ GI h d U) $¢ veL'S/ie- ;V 7
PHONE eL/ 3Y l 937/ EMAIL
CONTRACTOR'S NAME L°6coe- oo7e-,- OWNERBUILDER? 0YES[t49-
BUSINESS NAME //
ADDRESS 6a0 JV ry01Pr, Sk f V,f-✓/a/ LA 5�' ✓-V7
PHONE /ZR ,3q1 F,37( EMAIL
CONTRACTOR'S STATE LIC NUMBER 76.f7.S"-5-- LICENSE CLASSIFICATION L3 Co
VALUATION$ 12 5--Z) SQ L SQ FT
APPLICANT'S SIGNATURE - DATE 3 - 7
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BuILDLNG PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O 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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