PMT17-01647 City of Menifee Permit No.: PMT17-01647
29714 HAUN RD. Type: Residential Plumbing
�l-�CCEL/-> MENIFEE, CA 92586
MENIFEE Date Issued: 05/24/2017
PERMIT
Site Address: 25086 CORN FIELD CT,MENIFEE,CA Parcel Number: 339-413-026
92584 Construction Cost: $3,485.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE EXISTING 50GAL WATER HEATER-SAME SIZE AND LOCATION.
Work:
Owner Contractor
MICHEAL WILCOX A R S AMERICAN RESIDENTIAL SERVICES OF
25086 CORN FIELD CALIFORNIA INC
MENIFEE, CA 92584 965 RIDGE LAKE BLVD#201
Applicant Phone:9512769744
MENIFEE, CA License Number.765074
Phone:8006600675
Fee Description (,mil Amount 191
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
$116.15
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 carded 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_Pemnit_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 Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class C 100 �040 C3(O C�se o. 5 0 By my signature below l acknowledge that,except for my personal residence
Expires / Signature in which l must have resided for at least one year prior to completion of
1 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
O 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 3700 of the labor Code,for the performance of work for which www.leginfo.ca.goy/calaw.html.permit is issued.
Polity#
Date
PROPERTY OWNER OR AUTHORIZED AGENT
O I have and will maintain workers compensation insurance,as required by
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
Carrier \ l� with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#1(A(9bF5(Oc� Dj Expires I_(j, 1i 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,
Ishallnotemolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if l should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compe tmn p���JJx"ions of Section 3700 of the Labor
Code,)shall with co th ov' n Will the applicant or future building occupant handle hazardous material or
Applicant Date 8 (D mixture containing a hazardous material equal to orgreater that the
amounts specified an the Hazardous Materials Information Guide?
WARNI ALLURE TO SECURRKER'S COMPENSATION COVERAGE IS O Yes ®(Jo
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(SCAQM D)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY DYes !�PIVo
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 for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) o Yes boa
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjurythatlam exempt from the permitting checklist l understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health al Safe Code,S n 25505 25539 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 haza us feria)re 'ng.
Business and Professions Code).Any city or county that requires a permit toconstruc Date
issuance,also alter,Improve, applicantsh forrepair any
mistructure,
signed tts
o R OWNER ORA ORIZED AGENT
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(RRPj
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 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
ci 1,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-LEA6(5323).
Code;The Contractors 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. D 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.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK a
: Menifee
DATE S 2`1 I'1 PERMIT/PLAN CHECKNUMBER'I T-1-1--0I
TYPE: ❑COMMERCIALSRESIDENTIAL ❑MULTI-FAMILY El MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑NEW JKPLUMBING FIRE-ROOF-NUMBEROF SQUARES
DESCRIPTION OF WORK S�
PROJECT ADDRESS 6 (p �� 2r,��
ASSESSOR'S PARCEL NUMBER 339 • 1 1 •�,(P LOT Li Q(� TRACT 2.t-1Q
2.I
PROPERTY OWNER'S NAME/�W S1 COX JAf
ADDRESS ZSO Cf-tr M1 G�•
PHONE -I14 231 - 31S9 EMAIL
APPLICANT NAME
ADDRESS 3030 MYERS ST RIVERSIDE CA 92503
PHONE (800)660-0675 EMAIL
CONTRACTOR'S NAME RIGHTIME OWNER BUILDER? ❑YES❑✓NO
BUSINESS NAME AIRS
ADDRESS 3030 MYERS ST RIVERSIDE CA 92503
PHONE (800)660-0675 EMAIL
CONTRACTOR'S STATE LIICC NUMBER 765074 LICENSE CLASSIFICATION C10 C20 C36
VALUATION$ c31 y8S L SO FT
APPLICANT'S SIGNATURE DATE Z
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP
INVOICE PAID AMOUNT
AMOUNT I � ' I <%CASH C%CHECK# -CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT ",CASH ')CHECK# CCREDITCARO VISA/MC
OWNER BUILDER VERIFIED C,YES C NO OIL NUMBER NOTARIZED LETTER "-+ YES ) NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee. CA 92585 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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