PMT17-01027 City of Menifee Permit No.; PMT17-01027
29714 HAUN RD. Type: Residential Plumbing
<ACCE1LA--'1 MENIFEE, CA 92586
0---A MENIFEE Date Issued: 0 4/0 712 01 7
PERMIT
Site Address: 23710 CYPRESS PL, MENIFEE, CA Parcel Number: 350-262-031
92587 Construction Cost: $10,200.00
Existing Use: Proposed Use:
Description of REPLACE 30FT 3/4 PEX WATER SERVICE LINE
Work:
Owner Contractor
LINDA AYALA A R S AMERICAN RESIDENTIAL SERVICES OF
23710 CYPRESS PL CALIFORNIA INC
MENIFEE,CA 92587 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9012719700
ANDREW ALLEN License Number:765155
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIi
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Qtv Amount!$1
Piping/Repiping Single Family Residential 1 163.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 8.15
$199.16
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 canted 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
forfeited.
AA Bleg_Pennit_Templale.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 contractor(s)pursuant to the Contractors State License Law).
I hereby,affirm under penalty of perjurythat 1 am under provisions of
Chapter!)(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contactors State License Law for
Professions Code and my license is in full farce and effect. the following reason:
License Cl qq ✓ License No By my signature below I acknowledge that,except for my personal residence
Expires N� 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 I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
❑I hereby affirm under penalty of perjury one ofthe following declarations:I licensed contactors.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.leatnfo.ca.auv/calaw.htmL
this permit is issued.
Policy 0 Date
PROPERTY OWNER OR AUTHORIZED AGENT
-have and will maintain workers compensation insurance,as required by
4ection 3700 ofthe Labor Cade,for the performance ofthe work for which o mysignature below l certify to each ofthe following:I am the property
this permit is issued.My workers compensation insurance carrier and polity caner orauthonzed 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
Cartier 1 building co stru loath representatives ofthis city or county to
PolicyN V Expires enter th den.fi erty for inspection purposes.
(This section need not to be completed is the permit Isf rone-hundred Date gJ
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
,,"1'ertify that in the performance ofthe work for which this permit is issued,
I shall not employ any perso in any manner so.,33s to become subject to the CITY BUSINESS LICENSE 9
workers compensation s of C T nra,a ree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the work scorn �_Ilt
ion ions of Section 3700 ofth Labor
Code,)shall fp ith rov' iops. Will the applicant or future building occupant handle hazardous material ara
l/ mixture containing a hazardous material equal to or greater thatthe
Applicant Dale � amounts spe Fred on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATIO COVERAGE IS o Yes No
UNLAWFUL,AND SHALL SUBJECT AN 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 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 aYes _,A�u
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet ofthe
lending agency for the performance of the work which this permit is Issued outer boundary of a school?
(Section 3097 Civil Code) o Yes 1,:rN'o
OWNER BUILDER DECLARATIONS I have read the Hazardou aterial Information Guide and the SCAQMD
permitting checklist. nders my require underthe State of
I hereby affirm under penalty of perjury that l am exempt from the California Healt Safe de,Section and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous eria rting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 � o
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its ROPERiY OWNER OR AUTHORIZED AG ENT
issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions ofthe Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Section 70110)of Division 3 ofthe 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
a1,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 ofthe work,and the structure is www.epa.cov/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:
01,as owner ofthe 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
Menifee APR p 7 2017
DATE 4/- 7-1 PERMIT/PLAN CHECK NUMBER 010Z=
TYPE: ❑COMMERCIAL ZRESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA []SIGN
SUBTYPE: []ADDITION []ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑NEW g1PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK E q der
PROJECTADDRESS 157bo If ypress
ASSESSOR'S PARCEL NUMBER �� 2�[Z- J LOT 5�+ TRACT
OWNER NAME 41 41
ADDRESS .23 b 191@ 2 nivt Vallag , CA q,;7 i7
PHONE 7iLf- ,3/?5 -,3ito-- . EMAIL
APPLICANT NAME e-w (Leh
ADDRESS j�p w L-We 4- IVe✓ id CA 5's07
PHONE qsl 2M q,157)) EMAIL
CONTRACTOR'S NAME ft(�S e V pof2r OWNERBUILDER? ❑YES®NO
BUSINESS NAME
ADDRESS /6;10 w L I n den st A r✓eg Ide CA 17.,I,�7
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER S(S CENSE CLASSIFICATION
VALUATION$ ZO✓e26yo S L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION 1 CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN IP 2-3
INVOICE S' I PAID AMOUNT
AMOUNT OCASH OCHECKit CCREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES q NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
d3-7 ►o Cypress PI
`-ITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENT
PLAN APPROVAL oL�
REVIEWED BY V
ATE U
'Approval of these plans shall of be construed to be a permitter,or an
approval of,any violation of an provisions of the federal,state or city
regulations and ordinances. T is set of approved plans must be kept on the
jobsite until completion.
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C.I Mess I
City of Menifeo
Building & Safety Dept.
APR 0 7 2017
Received