PMT17-02825 City of Menifee Permit No.: PMT17-02826
29714 HAUN RD.
'fACCEL/-> MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 08/09/2017
PERMIT
Site Address: 26258 COLUMBUS DR, MENIFEE, CA Parcel Number: 338-194-009
92586 Construction Cost: $2,100.00
Existing Use: Proposed Use:
Description of REPLACE 40 GAL GAS WATER HEATER IN SAME LOCATION
Work:
Owner Contractor
WILLIAM RYAN A R S AMERICAN RESIDENTIAL SERVICES OF
26258 COLUMBUS 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 STREET
RIVERSIDE, CA 92507
Fee Description q_yt Amount ISI
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.
AP._Blde Pernit_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 perjurythat I am under provisions of with a licensed contractors)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 Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License CI 3 License No J�
of By my signature below I acknowledge that,except for my personal residence
Expires NI Signature inwhich l must have resided for at least one year priorta 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
❑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
this permit is issued. www.leginfo.ca.eov/calaw.htmL
Policy# Date
have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
Section 370D of the Labor Code,for the performance of the work for which ❑ myshgnature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and polity w> r authorized to act on the property ownefs behalf.1 have read this
number are application and the information I have provided is correct.I agree to comply
.r with all applicable city and coup nances and state laws relating to
Carrier ts building c stru .l auth representatives of this city or county to
Policy#J 6 d if,i I Expires enterth dentifh erty for inspection purposes.
(This section need not to be completed is the permit is tune-hundred /(r
dollars($100)or less Date
PROPERTY OWNER OR AUTHORIZED AGENT
.01—certify that in the performance of the work for which this permit is issued,
I shall not emolov any perso in any manner so to become subject to the CITY BUSINESS LICENSE#
worker's compensation s ofC l nia,a gree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the wor scam ion ions ofSection 3700 ofth Labor
Cade,)shall fo ith -wit rov ions. Will the applicant or future building occupant handle hazardous material or
Applicant Date Lf mixture containing a hazardous material equal to or greater thatthe
amounts spe filed on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATIO COVERAGE IS ❑Yes No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant orfuture building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
IN SECTION ON TO
06 OF
LABOR CODE,INTERDAMADATTOGES AS R ATTORVIDEDNEYS
FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR[ODE,INTEREST,AND AT70RNEY5 FEES for guidelines
CONSTRUCTION LENDING AGENCY oyes �o
1 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/dNo
OWNER BUILDER DECLARATIONS I have read the Hazardou aterial Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist. nder a my require under the State of
Contractor's License Law for the reason(s)indicated below by the California HeaR Saf de,Section and 25534 concerning
checkmark(s)l have placed next to the applicable item(s)(Section 7031.5 h5azardous eria rting.
Business and Professions Code).Any city or county that requires a permit to i❑*es o !J 7j! /
construct,alter,improve,demolish or repair any structure,prior to its Date LS
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 Contractor's 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 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
than($500). q P p p themselves
and property
managers who do the paint-disturbing work themselves or through their
❑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-LEAD(5323).
Code;The Contractor's 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 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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's 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 q PERMIT/PLAN CHECK NUMBER
TYPE: []COMMERCIAL ORESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: []ADDITION []ALTERATION []DEMOLITION ❑ELECTRICAL [—]MECHANICAL
❑NEW MPLUMBING ❑RE-ROOF-NUMBER OF SQUARES 1
DESCRIPTION OF WORK V�.0 111q�C L4c) OA�Ior a,cS L+I rr+ SQN'r I�C5�1�
PROJECT ADDRESS J5 ••� C01VMbCl5 r Meni/ee
odrely Dept.
ASSESSOR'S PARCEL NUMBER LOT TRACT AUG 0 t1 21
OWNER NAME )am 9 co'`
ADDRESS ; (oaSS COlvv m, Oy- Sir' Cr 6A ,125--6(a RecOlved
PHONE qs1-733- &009 EMAIL
APPLICANT NAME // p
ADDRESS /Sao !mil LrNGfi°vi �- Fi FVGr,SJ�C 64 9'7SD7
PHONE 251,3 y/937/ EMAIL
CONTRACTOR'S NAME {� OWNER BUILDER? ❑YES PLO
BUSINESS NAME A — �Lop•i-aT
ADDRESS 1 Sa-o CA rj , 07
PHONE 5- I 3`{ 4 3-71 EMAIL
CONTRACTOR'S STATE LIC NUMBER Sl SS SE CLASSIFICATION c 3&
VALUATION$ 2\O[� SO LSQFT
APPLICANT'S SIGNATURE DATE
L' *—
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP x
INVOICE PAID AMOUNT
AMOUNT , • v CASH G CHECK# "CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH "CHECK# :CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER C) YES 0' NO
City of(Nenifee Building&Safety Department 29714 Halm Rd. Allenlfee, CA 92586 951-672-6777
ww,v.Cityofinenifee,us Inspection Request Line 951-246-6213
i •
i ' CD
a
E
E a
` E c m Lm°
° w w N x E W m Y co W p
a N
g u�7 •+ o � M� ~ q
° S � c o
to
F- v o e a v es to
A
Q CD
3 ti SNT�S' a• w r c .
c Do
a s v
G ❑ ~ ` Y m L N t U to
WO d W N
IV 01 to
o f
r « E o
❑ �
ata O
0 a' N u o u
2
T N J p d Y a, E E Q 9
F N°
c @ mZ m L � a` S u o P
O Y y W '^ N U
•= E N A W '� Y! C in C LO v
m u « _
to
«vc •° f w aa•�W ecN° ��N° a;E_,
m va3:1l aW
vW
uM
ro $ a ' y LL ELP
3 L E a
o = goo
O
W C9 C C N v i
T O i� L W f�Cpa
Cl (( N O u T Q 1/uW1 d Y N a W y G
v ,
r
W 2 L v v _ d 9 `y� /E�
L J V C
o v � C
`° E in « E
'p a o N c w o 0 v u o E E o u 3
� � �
0 Z w rya b ` afro
O c
u E E W S
J m O c O 0 Z m w e .c �n S• ,�. a .W,
IL rv « « v n rn c E
a J rc Q N ? W a s �'.H Z E v o a x L..
paWWy Q v 2 z3 � E uttio � mm � m '�"
RZr4- ~ j R' u�i
_ W N
0 LL LL a W a N Q .i ry m 0 uu_.. a E t c 0 - .ti fV m
i
F N W�/W W aW. +. 9 Q m •. W C M O
� 3 3 0 L M ei Z
i
p O
h LL
0 E a
~ O U m {� C m
' v `w g
N C O' O I
S vL° m m m o w
O m
3 E O m
Y = « L W
� c
I"• U: h C 12 C Yil N W .v
m m C O 9 B \
OC = O " w G a m in
rl m c E E t 'o " v v �.
U w u m o o u, u a
c a [ m o m o m m c 'c
c T
u 'c N cIa '3 -" m M C
L
ami E m °y E m N o c « m a 0 y m
E O C m 0 '�" C O C C O aI N '
m O v m c « o
ti
L' E
3 w w a o c °
L y m E m m .mo m =a 12
Y,
Li: W C L C •` E c
E y `o �i `o m c N .=c 3 v m v
� N N N G O. C a m R W
wo
a m o o N N o
E w
v L c 9 tg C `o ui E m ` 'f_' a Z y = k m
m ou �° c m p• m 7 0 m ' if 'Ei a m c w c ¢ p •o
= m 2 u
m E d n $ o E v Y m « o m H
oL � Z m g
m V- E = c Y O 4 W
o' O c o J
.19
V •y +m' S am+ 'm' a = i, j F a w V O) J v
0
a m •c 3 C u' ai F- > c F
aci .°. E .mmc E a c c "' "' > c �°^ o z d' aY=7
U. b a C ,�? > G G a `O ` ^C L
Ow z 2 m v v
p.. m m m m o 3 Q m u
m Z a E w C rc x S in m u 0
M
vi r m of
uu
U a` C z u Q G u°_