PMT17-02937 City of Menifee Permit No.: PMT17-02937
29714 HAUN RD.
4gNCCELA? MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 08/1812017
PERMIT
Site Address: 29752 DESERT JEWEL DR, MENIFEE, Parcel Number: 340-180-009
CA 92584 Construction Cost: $1,976.00
Existing Use: Proposed Use:
Description of REPLACE 50 GALLON GAS WATER HEATER IN SAME LOCATION
Work:
Owner Contractor
JEWEL MCKINLEY A R S AMERICAN RESIDENTIAL SERVICES OF
29752 DESERT JEWEL DR 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 CALIFORNU
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description OQt Amount 1E1
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
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the B ss and ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
Ncense{ias/2 icense By7nysignaturebelowYacknowledge-that;-exceptiormypersonaimsldence
Expires /!) Signature in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARA ION 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 70"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 wwwleginfo.ca.gov/mlaw.htmi.
this permit is issued.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
ID have and will maintain worker's compensation Insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner 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
�U� lt„5 with all applicable city and county ordinan state laws relating to
Carrier building construction.I author or a[ives of this crty or county to
�jfS bSt
Policy# WC-7 Ep Expires fatj r7 enter the above identifi r o ' spection purposes. s�
(This section need not to be completed is the permit is for one-hundred Date s+ 7
dollars($100)or less PROPE OWNER OR AUTHORIZED AGENT
❑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#
worker's compensation laws of Calif agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers comp rovisions of Section 3700 of the Labor
Code,I shall forthwith ith those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant Date T �� amounts s ecified on the Hazardous Materials Information Guide?
FAILURE
WARNING: TO SEC RE WORKER'S COMPENSATION COVERAGE IS ❑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 Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY ❑Yes (JNo
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 Dplo
OWNER BUILDER DECLARATIONS 'I have read the Hazardous Material Infonna ion Guide and the SCAQMD
permitting checklist.I understand m r uema under the State of
I hereby affirm.under penalty of perjury that I am exempt from the p Z
California Health ISafety In ion w and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous material rep rt
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 DYes Ao 7 f� Q
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PROPEB.WOWNEkdR-AUTAORIZED 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 IRRPJ
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
❑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.epa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7D44,Business and Professions 1-800-424-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 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 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
Received Menifee
DATE 0- 17 PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL ORESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME POOL/SPA [-]SIGN
SUBTYPE: ❑ADDITION []ALTERATION []DEMOLITION []ELECTRICAL []MECHANICAL
❑NEW PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK i e- 1GL-e, So eytton QS L�Q r- eda-M'
IY1 Sall-e 0 cmA-%O,^
PROJECT ADDRESS aq Sa 1 'S�-r+ P....�e Dr
ASSESSOR'S PARCEL NUMBER 1�40 ,� • (�(�� LOT 1 TRACT 2
OWNER NAME ewe 1 C n le
ADDRESS 5 E' ,r'-�- 3e,let T("t t LA
PHONE (o Iq - Li I `I- I 0 RS EMAIL
APPLICANT NAME A f-tw 1 o/
ADDRESS C
i,l O w LI,YJC� Jr V I y-u-,I IAC
PHONE qSI Uj% 9311 EMAIL
CONTRACTOR'S NAME OWNER BUILDER? OYES NO
BUSINESS NAME C G b f
ADDRESS Sa.O { s- 2 NV ✓31r7LC �� �I -7
PHONE qJ I .31'I '�')3.7 I EMAIL
CONTRACTOR'S STATE LIC NUMBER -7 Lo J- 1 LICED LASSIFICATION C_3
VALUATION$ 7l/ L SQ FT
APPLICANT'S SIGNATURE DATE R --M
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 1, SMIP
INVOICE ` PAIDAMOUNT
AMOUNT 141 1 1 QCASH JCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH (CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED 'OYES O NO DL NUMBER NOTARIZED LETTER O YES 0 NO
City of Menifee Building&Sofety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
Ivww.cityofinenifee.us Inspection;Request Line 951-245-6213
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