PMT17-01477 City of Menifee Permit No.: PMT17-01477
29714 HAUN RD. Type: Residential Plumbing
'ACCELA7. MENIFEE,CA 92586
MENIFEE Date Issued:
05110/2017
PERMIT
Site Address: 27730 DURANT ST, MENIFEE,CA 92585 Parcel Number: 333-141-001
Construction Cost: $1.775.00
Existing Use: Proposed Use:
Description of REPLACE 50 GAL PROPANE WATER HEATER IN GARAGE
Work:
Owner Contractor
JANET HUGHES A R S AMERICAN RESIDENTIAL SERVICES OF
27730 DURANT ST CALIFORNIA INC
MENIFEE, CA 92565 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 city Amount IS)
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_Permft_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I herebyaffirm 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 Contractor's State License Law for
Professions Code and my license is in full force and effect. ' the following reason:
License CI s— .l 6 License No FJ�
qq By my signature below I acknowledge that,except formy personal residence
Expires Signature in which l must have resided for at least one year prior to completion of
Improvements covered by this permiL I cannot legallysella 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 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 worker's 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 370D of the Labor Code,for the performance of work for which y,,yleeinfa.ca.eov/calaw.html.
this permit is issued.
Policy#
Date
have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
ction 3700 of the Labor Cade,for the performance of the work for which D mynesignature below icertify to each of the following:lam the property
this permit is issued.My worker's compensation insurance carrier and policy wr or authorized to act on the property owner's behalf.l have read this
number are application and the information 1 have provided is correct.I agree to comply
Cartier with all applicable city and coun nances and state laws relating to
�g buildings stru lauth representatives of this city or county to
Policy If (�f/ (iiI Expires rb enterth dentifi arty for inspection purposes.
(This section need not to be completed is the permit is f r one-hundred
Date
dollars($100)or less
PROPERTY OWNER OR AUTHORIZED AGENT
1,0-rcertify that in the performance of the work for which this permit is issued,
I shall notemolov any perso in any manner so to become subject to the CITY BUSINESS LICENSE#
workefs compensation sof f nia,a ree that ifl should become HAZARDOUS MATERIAL DECLARATION
subject to the work =1 ion ' ions of5ection 37,00 ofth Labor
Code,IsIt 11 fo ith Fi wit rov ions. / Will the applicant or future building occupant handle hazardous material or
Applicant Date 6 (.( mixturecontafninga hazardous material equal to or greater that the
amounts spa Fied on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATIO DOVERAGEIS a Yi dNo
UNLAWFUL,AND SHALL SUBJECT AN 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 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 Dyes --dNo
I hereby affirm that under the penalty of perjury there is a construction VAII 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) Oyu 1IT90
OWNER BUILDER DECLARATIONS I have read the Hazardou aterial information Guide and the SCAQMD
l hereby affirm under penalty of perjury that lam exempt from the permitting checklist nde my require under the State of
Contractor's License Law for the reason(s)indicated below by the California Heal Saf de,Section and 25S34 concerning
checkmark(s)I have placed next to the applicable Item(s)(Section 703L5 h/azardous aria rting.
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 L L
Issuance,also requires the applicant for the permit to file a signed statement ROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRPj
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 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 7032.5 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 themselvesorthrough their
cal,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.epa.gov/lead/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 Contractor's State License Law does not apply to an owner of a DAn 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 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's 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
DATE PERMIT/PLAN CHECK NUMBER AT1 D
TYPE: ❑COMMERCIAL EI RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA [-]SIGN
SUBTYPE: []ADDITION ALTERATION ❑DEMOLITION []ELECTRICAL ❑MECHANICAL
❑NEW ❑PLUMBING [—IRE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK &0 leICC PJ' 1/019 Gdq lC/
in c r !!''
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER t LOT TRACT
OWNER NAME Janet-
ADDRESS 27733 Dorani- 6t go p C,
PHONE "Reee--75� ( EMAIL
APPLICANT NAME dtrw 2
ADDRESS l.Sdv r len St l- ole CA 5.25D7
PHONE 9S7 - 3kf/ -9--37/ EMAIL
CONTRACFCR'SNAME S JE'_ goof-el, OWNER BUILDER? DYES NO
BUSINESS NAME
ADDRESS 1520 bodo, uer31de CA ga5b7
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER j( LION SSIFICATION G�j(v
VALUATION$ [! 6- L SQ FT
11 APPLICANT'S SIGNATURE DATE .� I
CITYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION _^ CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN �J SMIP
INVOICE ,� MOUNT
AMOUNT I PAIDA OCASH OCHECKN 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECKR 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityo(menifee.us Inspection Request Line 951-246-6213
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