PMT17-01903 City of Menifee Permit No.: PMT17-01903
29714 HAUN RD.
�CCEL/� MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 06/14/2017
PERMIT
Site Address: 29916 SUGARFOOT CT, MENIFEE, CA Parcel Number: 338-111-015
92586 Construction Cost: $1,935.00
Existing Use: Proposed Use:
Description of REPLACE 40 GAL WATER HEATER IN GARAGE
Work:
Owner Contractor
MARGARET CANALES A R S AMERICAN RESIDENTIAL SERVICES OF
29916 SUGARFOOT COURT CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD#201
Applicant Phone:9512769744
CHRISTINA CALHOUN License Number: 765074
A R S INC DBA RIGHTIME
3030 MYERS STREET
RIVERSIDE, CA 92503
Fee Description Qtv Amount 131
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
$115.15
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA Bldg_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from Iicensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. ///777the following reason:
License Class C30 C2o C$f,D Li s No By my signature below l acknowledge that,except for my personal residence
Expires 1 Signature In which I must have re4ided for at least one year prior to completion of
WORKE improvements covered by this permit.I cannot legally sell a structure that I
R'S COMPENSATION DECLA
have hail[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 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 ,r,,ww,leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy# Date
BtSi 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 8-gy my signature below I certify to each of the folinvring: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
numberare: 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
build* canstruction.l hori re sentaY fthis city orcounty to
Polfry# '7(s31 SOSLe3101(g Expires D I en r e a ve id ed p p for ins c' n purposes.
(This section need not to be completed is the permit is for one-hundred �7
dollars($100)or less Date
PR OW A ED NT
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#
workers compen 'on laws of Calif rnia,and agree that if I should become
HAZARDOUS MATERIAL DECLARATION
subject to the or rs campers on pr i sof 1 3700 of
Labor
Code,I shall o I h cor a r th tl s p wsio Will the applicant or future building occupant handle hazardous material or
Applican Date JY /'7 mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARN . AILURE TO SECURE WORKER'S COMPENSATION COVE GE15 oyes lido
UNLAWFUL,AND SHALL SUBIECTAN 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 Districtconstruction
or modification
permitting checklist
IN SECTION 3705 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Airlines
Qua
CONSTRUCr10N LENDING AGENCY crYes D'No
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) D Yes Ao
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
1 hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the Caf.Forn' Ith&Safety de,Se S05 an 34 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 haza ou rial rep
Business and Professions Code).Any city or county that requires a permit to s D ate 5` 7
construct,alter,improve,demolish or repair any structure,prior to its Ty
OWNER OR AkTJWR1M 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 IRRPI
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 Iicensure receiving compensation for most work that disturbs paint In a pre-1978
and the basis for the alleged exemption.Any violation of Section 70315 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 theit
o 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.epa.aoy/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 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:
D 1,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.
SAFETY • Citq; if klenife
Buildin a De t
�,ileni ee JUN 14 2017
DATE (0 PERMIT/PLAN CHECK NUMBER , i ve d
TYPE: COMMERCIAL VUSIDENTIAL o MULTI-FAMILY a MOBILE HOME C:POOLISPA --SIGN
SUBTYPE: ' ADDITION O ALTERATION C:DEMOUTION D ELECTRICAL 0 MECHANICAL
; NEW 041PLUMBING C;RE-ROOF-NUMBER IOF SQUARES j--- �,{
DESCRIPTION OF WORK I�, C`1� G`1G� 'i'�-� ���Vc '1A-
OJECT RESS Z9911,0S G.t c0Cl . OSES�j
ASSESSOR'S PARCEL NUMBER A ^ ' 015 LOT TRACT
OWNERNAME
ADDRESS \ yc n
PHONE (IoZ6o (Z,Z. " 7L O� �)�EMAIL
APPLICANT NAME $�' L,..G�. I-'
ADDRESS p TY
PHONE ')57I -2(j/ — / / EMAIL
CONTRACTOR'S NAME l ((�� OWNER BUILDER? O YES"0
BUSINESS NAME . \�
ADDRESS �6 ' 7 Z��
PHONE $DU CdaO Z'5- EMAIL
CONTRACTOR'S STATE LIC NUMBER 7&5 67 LICENSE CLASSIFICATION CIO 4520 C3(0
VALUATION$ ( 3S L SQ FT
APPLICANT'S SIGNATURE ' DATE �7
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN 1 SMIP k
AMOUNT 1 116 .-
PAIDAMOUNT kirnoN 0 CASH 0 CHECK M J CREDiT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH Q CHECKR 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED YES QD NO DLNUMBER NOTARIZED LETTER i) YES 0 NO
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