PMT17-02823 City of Menifee Permit No.: PMT17-02823
29714 HAUN RD.
r/NCCEL/17. MENIFEE,CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 08/09/2017
PERMIT
Site Address: 29600 THORNHILL DR,MENIFEE, CA Parcel Number: 336-120-022
92586 Construction Cost: $1,650.00
Existing Use: Proposed Use:
Description of REPLACE 38 GAL GAS WATER HEATER IN SAME LOCATION
Work:
Owner Contractor
OLIVIA NUNEZ A R S AMERICAN RESIDENTIAL SERVICES OF
29600 THORNHILL DRIVE CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9012719700
ANDREW ALLEN License Number: 765155
A R S INC DBA RESCUE ROOTER
1520 W LINDEN ST
RIVERSIDE, CA 92507
Fee Description ON Amount l$1
Residential Water Heater 1 8300
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 4A 5
$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_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 700D)of Division 3 of the Business and o I am exempt from Ilcensure under the Contractors5tate License Law for
Professions Code and my license is in full force and effect. . the following reason:
License Cl its ✓ License Na, By my signature below l acknowledge that,except for my personal residence
Expires 9[ Signature tlIn which l must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legallysell 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 ofthe 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 eve liable 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 ,aw,ty,feeinfo.o.eov/calaw.html.
this permit is issued.
Policy# Date
-have and will maintain worker's compensation insurance,as required by PROPE OWNER OR AUTHORIZED AGENT
fection 3700 of Lahor[ode,forthe performance ofthe work for which o mysignature below I certify to each ofthe following:I am the property
this permit is issued.My worker's compensation Insurance carrier and polity wner 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
With all applicable city and coup nances and state laws relating to
Lanier bulldingm stru .loath representatives of this city or county to
Policy# 14 Expires enterth dentifi erty for inspection purposes.
(This section need not to be completed is the permit is 4rone-hundred
Date
dollars($100)or less
PROPERTY OWNER OR AUTHORIZED AGENT
�ertifythat in the performance of the work for which this permit is issued,
I shall not emolov any perso in any manner&op to become subject to the CITY BUSINESS LICENSE#
workers compensation sofC I' ' a tee that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the war s cam �ion . ions of Section 3700 of th Labor
Code,Ishall fo Ith wit o rov ions. r Will the applicant or future building occupant handle hazardous material or
Applicant Date V mixture containing a hazardous material equal to or greater that the
amount:;sppecIfied on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATrd COVERAGE IS o Yes No
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 occupant Quality Management econt(SCAQMo)modifiee etion fro checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Airllnes
Qua
CONSTRUCTION LENDING AGENCY oYes _tf�h.
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) ❑Yes/d"o
OWNER BUILDER DECLARATIONS I have read the Hazardou aterial Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that lam exempt from the permitting checklist. nder my require under the State of
Contractors License Law for the reason(s)indicated below by the California'u Healt Saf de,Section and 25534 concerning
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 hazardous eria rting. /J'`Wes 0 ,} i]
Business and Professions Cade).Any city or county that requires a permit to Date `D L
construct,alter,improve,demolish or repair any structure,prior to its 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(RRP)
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 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($500). managers who do the paint-disturbing work themselves or through their
o 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion ofthe work,and the structure is www.eoa.e0v/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement Is sold within one year of Firm Certification No.:
completion,the Owner-Bu)lder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required forthis project because:
o I,as owner afthe property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING : SAFETY PERMIT/PLAN CHECK APPLICATION
,
Menifee
DATE t 'L 17 PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA [—]SIGN
SUBTYPE: []ADDITION ❑ALTERATION []DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑NEW PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK q l I• d�g & Safety
9 W1
PROJECT ADDRESS p S CA z-
ASSESSOR'S PARCEL NUMBER LOT TRACT f `ecel
OWNER NAME VI G U ' e
ADDRESS agta(�u D/' \\ { - C.. GA 9a5$(a
PHONE (O104- 150- 113q EMAIL
APPLICANT NAME
ADDRESS 5,?O /VG/' / GA 2 67
PHONE 51- 341- q 3-71 EMAIL
CONTRACTOR'S NAME OWNERBUILDER? DYES
NO
BUSINESS NAME 2 Wg oOq-2l
ADDRESS 15ao bJ I eye —+- River,51de CA ;)5O'7
PHONE q'Sl- 3ti EMAIL
CONTRACTOR'S STATE LIC NUMBER -7(oSISS N LASSIFICATION C 3(p
VALUATION$ LSO FT
APPLICANT'S SIGNATURE DATE $ I
ct_iy'FAWUSE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP k
INVOICE 1AMOUNT I\5. g PAID AMOUNT \ I
�%CASH C"CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menif'ee Building&Safety Deportment 29714 HDun Rd. rrVenifee, CA 92586 951-572-6777
vvvvw.cityofinenifee.us Inspection Request Line 951-246-6213
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