PMT17-02425 City of Menifee Permit No.: PMT17-02425
29714 HAUN RD.
'ACCEL/-> MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued:
0 711 212 0 1 7
PERMIT
Site Address: 26021 BONITA VISTA CT, MENIFEE,CA Parcel Number: 337-410-015
92586 Construction Cost: $3,275.00
Existing Use: Proposed Use:
Description of REPLACE 40 GAL GAS WATER HEATER, SAME LOCATION IN GARAGE
Work:
Owner Contractor
STEPHEN&ANN ELISANDO A R S AMERICAN RESIDENTIAL SERVICES OF
26021 BONITA VISTA CT CALIFORNIA INC
MENIFEE,CA 92586 965 RIDGE LAKE BLVD#201
Applicant Phone:9512769744
KENNY PERRY License Number. 765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIU
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
Fee Description Qtv Amount($)
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_Bidg_Pennit 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 ❑I 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 Claw CLo,C 2D�C,3(_License No. 26 61 By my signature below l acknowledge that,except for my personal residence
Expires_ '&-30.tfftature in which l 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
,pI hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that copy of the applicable law,Section
have and will maintain a certificate or 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.IeRinfo.m.gov/caIaw.htmI,permit is issued. vr
Policy It Date
o I 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 ❑By my signature below l certify to each of the followng: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 coned I agree to comply
Cartier L(�� �! with all applicable city and county ordinances and state lava relating to
building construction.I authorize representatives of this city or county to
Policy fl 7-401 [JSL(T,761!/ 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
a Icertify that in the performance of the work for which this permit is issued, (3-5t>
I shall not emolov 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 ZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Cade,I shall forthw'th comply with those provisions. �7 ill the applicant or future building occupant handle hazardous material Ora
Applicant Date `~ mixture containing a hazardous material equal to or greater that the
^ram - Y amounts specified on the Hazardous Materials Information Guide.
WARNING:FAILURE TO S RE WORK S COMPENSATION COVERAGE LS aYes J0<0
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 OYes o
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 a,W
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that l am 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 Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 OY ❑No
Business and Professions Code).Any city or county that requires a permit to ,�JpJjyl Date__
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR IV®RI issuance,also requires the applicant for the permit to file a signed statement C�
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING fRRPI
License Law(Chapter9(commencing with Section 700D)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he orshe 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 Sectiaq 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 penalWof not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
o I,as owner of the property,or my employee with wages as theirsole employees.For more information about EPA's Renovation Program visit:
compensation,will doI )all of or( )portion of the work,and the structure is www.ena.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80DA24-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 Improverned 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 bemuse:
D 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.
APPLICATION
BUILDING & SAFETY PERMIT/PLAN CHECK
Menifee
DATE 7 PERMIT/PLAN CHECK NUMBER rl -Oa
TYPE: O COMMERCIAL hESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Ald
PROJECT ADDRESS :� /y✓/ �G �SF /li(C /� �� ' r 3(J ICJy�
ASSESSOR'S PARCEL NUMBER LOT TRACT -E�rj��P
OWNER NAME
i nn
ADDRESS =7 - 17• T
PHONE < , /J'�-7.c �y EMAIL
APPLICANT NAME
ADDRESSI�
PHONECld) �ExGLi' C !J EMAIL
CONTRACTOR'S NAME �.^ OWNER BUILDER? O YES O NO
BUSINESS NA
MfEE d
ADDRESS JG/�. "� %✓ 7ZS ��-, /I�'�O'�`7� C//
PHONE If) Cv�,r�—C`Kc� �S EMAIL
CONTRACTOR'S STATE LIC NUMBER '76 LICENSE CLASSIFICATION 4&' G,ZCI �3�I
VALUATION$ j LR 7:5 Lam; SO FT /I 37% L SQ FT
7-1
APPLICANT'S SIGNATURE -.''� L �.C�,Z DATE 19-17
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN / SMIP
INVOICE n PAIDAMOUNT
AMOUNT •I OCASH CHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd.Menifee, CA 92586 951-6 72-677 7
www.cityofinenifee.us Inspection Request Line 951-246-6213
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