PMT17-00826 City of Menifee Permit No.: PMT17-00826
29714 HAUN RD.
�CCEL/17. MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 0 311 612 01 7
PERMIT
Site Address: 25885 WARWICK RD, MENIFEE, CA Parcel Number: 339-063-009
92586 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of ADD 3/4"IN,53 L FT GAS LINE FROM METER TO KITCHEN"INSPECTOR PLEASE VERIFY JOINTS
Work: FOR CORRECT PIPE PUTTY&GAS TEST INSPECTION"*
Owner Contractor
SHELDON ALECHMAN A R S AMERICAN RESIDENTIAL SERVICES OF
25885 WARWICK RD CALIFORNIA INC
MENIFEE,CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9512769744
CHRISTINA CALHOUN License Number:765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIU
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description DDtt Amount l5l
Piping/Repiping Single Family Residential 1 163.00
Building Permit Issuance 1 27.00
Inspections not specified 116 116.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 8.15
$316.15
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 staled,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
forleited.
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 Lawj.
Chapter9(commencing with section 7000)of Division 3 of the Business and in I am exempt from Iicensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class0c Cw v3 lle Uc 5;N GIPO By my signature below I acknowledge that,except for my personal residence
Expires ar+ Signature in which I 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 DECLA have built as an owner-builder if it has not been constructed in its entirety by
❑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.Ieginfo.ca.goy/caIaw.htmI.permit is issued.
Policy it Date
^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 o By my signature below I certify to each of the following:I am the property
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
number are: application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier -. .i^+e�2— 11^^tt building construction.l authorize representatives of this city or county to
Policylil-la SL.R.AfJ�WIDExpires 11b I I 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
❑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 If
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the rkers com atio ¢ions Lion 3700 o the La r
Code,I shal o w" I c twit e o i r s. Will the applicant or future building occupant handle hazardous material or a
Applican Date mixture containing a hazardous material equal to or greaterthat the
amounts specified an the Hazardous Materials Information Guide?
WARN G: RE TO SEC ORKER'S COMPENSATION VE E Is o Yes pWo
UNLq L,AND SHALL SUBIECTAN 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 forthe 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 for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes cDW
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 far the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) ❑Yes d7io
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjurythat I am exempt from the permitting checklist.I understand my requirements underthe State of
Contractors License Law for the reason(s)indicated below by the California Health&Safe o e,5 o 7ate
25534 concerning
hazard a 'al r o 1
checkmark(s)I have placed next to the applicable hems)(Section 7031.5 �Fe
Business and Professions Code).Any city or county that requires a permit to
construct,alter,Improve,demolish or repair any structure,prior to its RO 34
OWNER A RIZEDAG T
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 Cade)or that he or she is exempt from Iicensure receiving compensation for most work that disturbs paint Ina pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certifled 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($500). managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD.(5323).
Code;The Contractors.State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
o I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
a
Menifee
DATE �� \rI PERMIT/PLAN CHECK NUMBER ��(Q
TYPE: 0 COMMERCIAL RESIDENTIAL O MULTI-FAMILY MOBILE HOME POOL/SPA C SIGN
SUBTYPE: O ADDITION ALTERATION O DEMOLITION : ELECTRICAL % MECHANICAL
O NEW S�LUMBING ^_. RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK L1, a l V%_ + ` 1 YYN ► %0v - Q
PROJECTADDRESS 'ZS$SS f L;Z' JY-, 2,
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
ADDRESS
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME k+C� OWNER BUILDER? '-, YES
O
BUSINESS NAME
ADDRESS Q
PHONE BOO [Q(�,O Q(p'J $� EMAIL
CONTRACTOR'S STATE LIC NUMBER ?(OSZ1 4 LICENSE CLASSIFICATION QO GZO C_S(o
VALUATION$ J Q S L SQ FT
APPLICANT'S SIGNATURE - DATE I7
t .:ii.
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE 2 PAID AMOUNT -
AMOUNT iJ �I CASH CHECK# CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT ^ CASH 'CHECK# '-'CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER C YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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