PMT17-00934 City of Menifee Permit No.: PMT17-00934
29714 HAUN RD.
�CCELA7. MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 03/29/2017
PERMIT
Site Address: 29638 BROOKFIELD DR, MENIFEE, CA Parcel Number: 338-234-016
92586 Construction Cost: $5,430.00
Existing Use: Proposed Use:
Description of INSTALL NEW TANKLESS WATER HEATER IN GARAGE
Work:
Owner Contractor
HELEN SIMEON A R S AMERICAN RESIDENTIAL SERVICES OF
29638 BROOKFIELD DRIVE CALIFORNIA INC
MENIFEE,CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9512769744
CHRISTINA CALHOUN License Number: 765074
A R S INC DBA RIGHTIME
3030 MYERS STREET
RIVERSIDE, CA 92503
Fee Description O_yt Amount tbl
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.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 Law).
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 Class C.IIO C.ZO C3 Q C qse o. 5 O By my signature below I acknowledge that,except for my personal residence
Expires 30j1 7 Signature U in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
❑1 hereby affirm under penalty of perjury one of the following declarations:) 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.leginfo.n.gov/�law.htmi.permit is issued.
Policy# Date
D l 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 a 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.)agree to comply
with all applicable city and county ordinances and state laws relating to
Carder \�32J� building construction.)authorize representatives of this city or county to
Policy#7(034.�6PJ(OcS �) Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is Far one 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 emolov 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 tionp ronsof ction3700 of the Labor
Cade,I 2!AILW4UREtIOSEC�URA
wih co th osgaovi.' n p Will the applicant or future building occupant handle hazardous material or
Applica Date CJ La mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARN I RKER"S COMPENSATION COVERAGE IS 0 Yes 0410
UNLAWFUL,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 for the construction or madification 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 forguldelines
CONSTRUCTION LENDING AGENCY 0 Yes 0140
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 Cade) D Yes 4040
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.)understand my requirements underthe State of
Contractors License Law for the reason(s)indicated below by the California Health&Safe Code,S n 25Zate
25534 concerning
checkmark(s)I have placed next to the applicable item(s).(Section 7031.5 haza us terial re 'ng.
Business and Professions Code).Any city or county that requires a permit to s D
construct,alter,improve,demolish or repair any structure,prior to its Z�J
issuance,also requires the applicant for the permit to rile a signed statement R OWNER OR A&TMORIZED AGENT
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 70DD)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 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.eoa.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 D 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:
a 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
APPLICATION& SAFETY PERMIT/PLAN CHECK �:
DATE L3 2 1^( PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL tj dESIDENTIAL Q MULTI-FAMILY MOBILE HOME :' POOL/SPA SIGN
SUBTYPE: ADDITION 0 ALTERATION C DEMOLITION '' ELECTRICAL -` MECHANICAL
NEW V4XLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS Z9 -S
ASSESSOR'S PARCEL NUMBER 20 5_ 034' CA U LOT TRACT
City of Menifee
OWNER NAME StV11{nn
ADDRESS qq�eA/y.-..tom
PHONE (/D I) j;Jo,��-1� 1 tog EMAIL
APPLICANT NAME VV1(V5 Ckj
ADDRESS 0, coy-, �cn.
PHONE EMAIL
CONTRACTOR'S NAME fZ OWNER BUILDER? C'YES SRO'
BUSINESS NAME "
p
ADDRESS -96�6 'S�-• P—IV
PHONE UQd &620 d(p-7 EMAIL
CONTRACTOR'S STATE LIC NUMBER 7&S-_0 -7 LICENSE CLASSIFICATION GO CZO G3(0
VALUATION$ 5 SQ L$Q FT
APPLICANT'S SIGNATURE ATE L 7
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 1 SMIPINVOICE >G.
AMOUNT l I Fj ',� PAID AMOUNTI (I C., r,
-✓ CASH CHECK CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT C CASH CHECK R --'CREDITCARD VISA/MC
OWNER BUILDER VERIFIED '-'YES -- NO DL NUMBER NOTARIZED LETTER YES () NO
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