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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 W N I-+ .D w S ."O 3 n m 2 d 1O+ D N Q. m 0 a -4 A p H ,'Lmj D G Z_ Z = N D A m m D w In° 9 O r o a 9 s 9 O g ° � _ � cor n ° A�m1 r n m A p p N Q m m °i (/7 m O 3�' v (� Z o m O ,°,. 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