PMT17-02938 City of Menifee Permit No.: PMT17-02938
29714 HAUN RD.
�CCELA�. MENIFEE, CA 92586 Type: Residential Plumbing
...... MENIFEE Date Issued: 08/18/2017
PERMIT
Site Address: 25810 INTELECHEN DR, MENIFEE,CA Parcel Number: 339-123-017
92586 Construction Cost: $20,300.00
Existing Use: Proposed Use:
Description of REPLACE DRAIN LINES FOR TWO BATHROOMS INSTALL LINER ON KITCHEN/LAUNDRY AND
Work: SEWER LINES
Owner Contractor
TOM WEST A R S AMERICAN RESIDENTIAL SERVICES OF
25810 INTELECHEN DR CALIFORNIA INC
MENIFEE,CA 92586 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 gtty Amount 1$1
Plumbing Fixtures and Vents, fixtures 2 116.00
Piping/Repiping Single Family Residential 1 163.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 13.95
$320.95
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 staled,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 exemptfrom licensure under the Contractor's State License law for
Professions Code and my license is in full force and effect. the following reason:
License Class q�q License S By my signature below I acknowledge that,except for my personal residence
Expires /✓ 11/ Signature in which I must have resided forest least one year prior to completion of
ON improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARAI
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 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.leRinto_ca.gov;cal.lw.html.
this permit is issued.
Policy# Date
o lI have and will maintain worker's 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 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 owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
(Q(,/'(- �N5 with all applicable city and county ordinance state laws relating to
Carrier building construction.I author' epr atives of this city or county to
=7fT b,51 enter the above identifi ro o " sectionpurposes.
Policy# (nIGZ Expires /i)/ /T /? fj P 5�
(This section need not to be completed is the permit is for one-hundred v Date f V ) 7
dollars($300)or less PROPERK9NER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSES
worker's compensation laws of Calif agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers corn p rovisions of Section 3700 of the Labor
Code,I shall forthwithf:a Ith those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date % 'rJ [7 mixture containing a hazardous material equal to or greater that the
amountspecified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SEC RE WORKER'S COMPENSATION COVERAGE IS ❑Yes b No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building bythe 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 for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes eNo
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 oplo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm.under penalty of perjury that I am exempt from the. permitting checklist.I understand ray ements under the State of
Contractors License Law for the reason(s)indicated below by the California Health al Safety Code; ion 25 and 25534 concerning
hazardous material re .
checkmark(s)I have placed nett to the applicable item(s)(Section 7031.5 nYes ❑AVo p �1
Business and Professions Code).Any city or county that requires a permit to / Date r 0 '' I
construct,alter,improve,demolish or repair any structure,prior to its pROPF�. W OWNE R AU ORIZED 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 fRRP)
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
❑I,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 ov 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 ❑An EPA Lead-Safe Certified Renovator will be responsible forthis project
property who,through employees'or personal effort,builds or improves the
property provided thatthe 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 provingthat 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 /PLAN CHECK APPLICATION
M e n i f e e
DATE g 1? PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL ❑RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: [:]ADDITION ❑ALTERATION []DEMOLITION ❑ELECTRICAL [I MECHANICAL
[—]NEW 0 PLUMBING [IRE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK y-a,, br)e,A9 �OJ INo .�a¢hroo S
ffSfu �� �liDCr yT IlGb 1dUr7p/l o7Q/ rr r7Ct
PROJECTADDRESS • ec'hen
ASSESSOR'S PARCEL NUMBER 1 Z3 • DI J LOT TRACT �Z
OWNER NAME 722M 4t/.c25e d
ADDRESS a 9-8/0 ?f-e1CCb6v? n CA 'F;5_ &
PHONE ,BIOS- 5-87- 71-I'77 EMAIL
APPLICANT NAME w 411ell
ADDRESS ID-0 "/ Z / �e,7 9&er lh o
PHONE 95/ 3w F37/ EMAIL
CONTRACTOR'S NAME Aks E df Aiootcrr OWNERBUILDER7 ❑YES NO
BUSINESS NAME /
ADDRESS /5--=10 st Rju,,sl4le C.4 .9427
PHONE 95731/I57J7/ EMAIL
CONTRACTOR'S STATE LIC NUMBER /.yam- _ UCf171,SE.LLASSIFICATION C 3
VALUATION$ Z o/ 3 U S9-E.T %�" / L SO FT
i /
APPLICANT'S SIGNATURE '�1��� DATE Y / 9 7
6 , MEOW
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP b �.
INVOICE PAID AMOUNT
AMOUNT • =% CASH %CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT C% CASH ;:CHECK# C?CREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES G NO
City of Nienifee Building& Safety Department 29714 HOUn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
59/0 /»tcr/ecbcn Or
City of Menifee
AUG 18 2017
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1, JILDING AND SAFETY DEPARTMENT
Pi.AN APPROVAL
REVIEWED BY
DATE
`Approval of these plans shall not he construed to be a permit for,or an
approval of,any violation of any provisions of the federal,state or city
regulations and ordinances. This set of approved plans must be kept on the
jobsite until completion.