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PMT17-01854 City of Menifee Permit No.: PMT17-01854 29714 HAUN RD. �A-CCEL/> MENIFEE, CA 92586 Type: Residential Plumbing MENIFEE Date Issued: 06/12/2017 PERMIT Site Address: 28735 AUTUMN LN, MENIFEE, CA 92584 Parcel Number: 372-420-005 Construction Cost: $4,576.00 Existing Use: Proposed Use: Description of REPLACE BACKWATER DEVICE IN GARAGE Work: Owner Contractor ROGER COPP A R S AMERICAN RESIDENTIAL SERVICES OF 28735 AUTUMN LN CALIFORNIA INC MENIFEE,CA 92584 965 RIDGE LAKE BLVD SUITE 201 Applicant Phone:9012719700 ANDREW ALLEN License Number:765155 A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIr 965 RIDGE LAKE BLVD SUITE 201 MEMPHIS,CA 38120 Fee Description Qtv Amount(S) Plumbing Fixtures and Vents,fixtures 1 116.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Plumbing 1 5.80 $149.80 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 bulliding 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_81dg_Permit Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects hereby affunn under penalty of perjury that 1 am under provisions of with a licensed contractor(s)pursuant to the Contractors State license Law). Chapter9(commencing with section 700D)of Division 3 of the Business and o I am exempt from Iicensure under the Contractors State License Law for Professions Code and my license is in full force and effect the following reason: License CI qq License No By my signature below I acknowledge that,except for my personal residence Expires N Signature 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 D 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 websile: by Section 3700 of the Labor Code,for the performance of work for which ,„A„A,-leeinfo.ca.eov/oiaw.html. this permit is issued. Policy It Date ave and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT ection 3700 of the Labor Code,for the performance of the work for which D my signature below I certify to each of the following:I am the property this permit Is issued.My workers compensation insurance carrier and polity wrier or authorized to act on the property owner's behalf.I have read this number are application and the information I have provided is correct.I agree to comply ,r with all appicmble city and court nances and state laws relating to Cartier building cci stru I au!Werepresentativu of this city or county to PoliryN a y, Expires enterth dentifi erty for inspection purposes. (This section need not to be completed is the permit Is i1r, one-hundred ^ �(, Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT �ertify that in the performance of the work for which this permit is issued, 'I shall not emolov any perso fn any manner so to become subject to the CITY BUSINESS LICENSE g workers compensation sofC 1" nia,a ree thatif lshouid become HAZARDOUS MATERIAL DECLARATION subject to the work s com,�PP�ion ' tuns af5ection 3700 ofth Labor Code,I shall fo ith (/n/pI wit o rov ions. / Will the applicant or future building occupant handle hazardous material ora Applicant Date S �.f mixture containing a hazardous material equal to or greater that the amounts spe fled on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATIO COVERAGE IS D Yes No UNLAWFUL,AND SHALLSUBIECTAN 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 forguldel�ines CONSTRUCTION LENDING AGENCY 0 Yes -ONO N0 I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 100D 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) D Yes IIANo OWNER BUILDER DECLARATIONS I have read the Hazardou aterial Information Guide and the S(AQMD I hereby affirm under penalty of perjurythat 1 am exempt from the permitting checklist. side a my require under the State of Contractors License Law for the reason(s)indicated below by the California Healt Safe de,Section and 25534 concerning checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 h/azardous eria rung. Business and Professions Code).Any city or county that requires a permit to A*es Date construct,alter,improve,demolish or repair any structure,prior to its L l ROPERTY OWNER OR AUTHORIZED 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 IRRP) License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RAP)Rule requires contractors Business and Professions Code)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 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 D 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.zov/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 uAn 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: 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. BUILDING • APPLICATION Jj yg3, . I _ ,Menifee DATE (o - C1 11 PERMIT/PLAN CHECK NUMBER (� -101 D TYPE: [-]COMMERCIAL ❑RESIDENTIAL [-]MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN SUBTYPE: [-]ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL ❑NEW QPLUMBING ❑RE-ROOF-NUMBEROFSQUARES DESCRIPTION OF WORK 2G c. a a'Q✓ 1/� a r PROJECTADDRESS OLQ1 otut&y\ Y\ 5 ASSESSOR'S PARCEL NUMBER 3'Ip1 .�(-�o`�OS LOT TRACT OWNER NAME fzC e ( CO ADDRESS 5 q t 6L PHONE 6 Wz) EMAIL APPLICANT NAME �,w . L�6&n ADDRESS J0.Nat G J PHONE 17sk EMAIL CONTRACTOR'S NAME OWNER BUILDER? ❑YESE NNO BUSINESS NAME QQ ADDRESS SeZO —) L-k�aBN C a PHONE 93111 -y EMAIL CONTRACTOR'S STATE LIC NUMBER / (P,5-i LICENSE CLASSIFICATION C Co VALUATION$ L-{ to-7 Le S L SQ FT APPLICANT'S SIGNATURE DATE Co -/L - / DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAIDAMOUNT AMOUNT OCASH OCHECK# 0CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUM OCASH OCHECKk OCREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZEDLE17ER O YES O NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-5213