PMT17-01439 City of Menifee Permit No.: PMT17-01439
29714 HAUN RD. Type: Residential Plumbing
�CCELA? MENIFEE, CA 92586
MENIFEE Date Issued:
05/04/2017
PERMIT
Site Address: 27187 POTOMAC DR,MENIFEE, CA Parcel Number: 336-190-010
92586 Construction Cost: $2,850.00
Existing Use: Proposed Use:
Description of REPLACE 40 GAL GAS WATER HEATER IN GARAGE
Work:
Owner Contractor
JANET WILLIAMS A R S AMERICAN RESIDENTIAL SERVICES OF
27187 POTOMAC DR 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 Oty Amount 1$1
Forced-Air or Gravity-Type Furnace or Sumer 1 149.00
Air Handling/Condensing Units SFR 1 133.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Mechanical 1 14.10
$324.10
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 contractor(s)pursuantto the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and 0I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License C��las�s6�loo cw es te Uc s N . By my signature below I acknowledge that,except for my personal residence
Expires�yt/J�Signature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECIA improvements covered by this permit.l cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
0 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.aov/calaw.lstml.
this permit is issued.
Policy q Date
yT-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 0 By my signature below I certify to each of the following:)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
Carrier cl iv+�`� with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy 11111 lJf.XJ3NI tD Expires 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
o 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 H
workers compensation laws of California,and agree that if I should became HAZARDOUS MATERIAL DECLARATION
subject to the rkers com p atio 576
eDate
tion 3700 o the La r
Code,I shal o Iw'h c i/wit ^7 WIII the applicant or future building occupant handle hazardous material ora
Applican / / mixture containing a hazardous material equal to or greater that the
amounts specified an the Hazardous Materials Information Guide?
WARN G: RE TO SE[ ORKER'S COMPENSATION VE E IS 0 Yes Pilo
UNLA 4 AND SHALL SUBJEcrAN EMPLOYER TO CRIMINALPENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY o Yes Cfb
I hereby affirm that under the penalty of perjury there is a construction WIII the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) ❑Yes Olio
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that 1 am exempt from the
Contractors License law for the reason(s)indicated below by the California HealthWN
Safe2550 25534 concerning
hazard na lair
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Wfe
Business and Professions Code).Any city or county that requires a permit to Date f
construct,alter,improve,demolish or repair any structure,prior to its RQ OWNER A RIZEDAGE T
issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRPI
License Law(Chapter9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure
978
and the bask for the alleged exemption.Any violation of Section 7031.5 by residence compensationformastworkthatdisturbspaint ina ply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required pra or ctices.
his includesy to
he cal property-certified ownersirms and prole with
than($S00). required practices.This includes rental properly owners and property
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.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 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. o No EPA Lead-Safe Certified Firm is required for this project because:
01,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7D44,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
-1enifee
DATE S PERMIT/PLAN CHECK NUMBER
TYPE: COMMERCIAL ❑MULTI-FAMILY ❑MOBILEHOME POOL/SPA ❑SIGN
SUBTYPE: [-]ADDITION []ALTERATION []DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑�N/EW MBING ❑RE-ROOF-NUMBER/O-FSQUARES
DESCRIPTION OF WORK - -)a'J'�Y
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER ! `�• I�O'T0 10 LOT l TRACT
PROPERTY OWNER'S NAME w,11t v(A,
ADDRESS ?'-
PHONE (950 (g19 - nJOS EMAIL
APPLICANTNAME 1 "vv—1
ADDRESS 3030 MYERS ST RIVERSIDE CA 92503
PHONE (800)660-0675 EMAIL
CONTRACTOR'S NAME RIGHTIME OWNER BUILDER? ❑YES❑✓NO
BUSINESS NAME ARS
ADDRESS 3030 MYERS ST RIVERSIDE CA 92503
PHONE (800)660-0675 EMAIL
CONTRACTOR'S STATE LIC NUMBER 765074 LICENSE CLASSIFICATION C70 C20 C36
VALUATION$ 5 L SO FT
APPLICANT'S SIGNATURE DATE 7
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAIDAMOUNT -
AMOUNT CASH CICHECKk CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT C CASH C CHECK It O CREDITCARD VISA/MC
OWNER BUILDER VERIFIED --YES ii NO DL NUMBER NOTARIZED LETTER C YES 0 NO
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