PMT17-03134 City of Menifee Permit No.: PMT17-03134
29714 HAUN RD.
<ACCEL/> MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 09/05/2017
PERMIT
Site Address: 31287 CORTEZ ST, MENIFEE,CA 92584 Parcel Number: 372-362-002
Construction Cost: $6,000.00
Existing Use: Proposed Use:
Description of REPAIR 3 L FT OF SEWER LINE
Work:
Owner Contractor
BRAD CLORE A R S AMERICAN RESIDENTIAL SERVICES OF
31287 CORTEZ STREET 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 CALIFORNIi
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Oty. Amount 1$1
Sewer 1 150.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 7.50
$185.50
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_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 herehy,affirm under penalty of perjurythat I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractofs State License Law for
Professions Code and my license is in full force and effect the following reason:
License Cl _f ✓ License No By my signature below l acknowledge that,except for my personal residence
qqf
Expires 41 Signature in which l 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 DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
n 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
this permit is issued. www.leginfo.ca.¢ov/calaw.html.
Policy g Date
�Lhave and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
bection 3700 of the Labor Code,for the performance of the work for which opY/mysignature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy w6 ner cr 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
Carrier 'r I with all applicable city and coun rnances and state laws relating to
�g build' stru Iauth representatives of this city or county to
Policy If — (y1 Expires enterth den tifi erty for inspection purposes.
(This section need not to be completed is the permit is flir one-hundred
Date
dollars($100)or less
PROPERTY OWNER OR AUTHORIZED AGENT
.0-�Certify that in the performance of the work for which this permit is issued,
-I shall notnot em_p_ylov any perso in any manner sa to become subject to the CITY BUSINESS LICENSE ff
workers compensation s of C I' nia,a ree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the war s cor9P�ion 'tons of Section 3700 ofth Labor
Code,Ishall fo ith fn -wit o rov ions. / Will the applicant or future building occupant handle hazardous material or
Applicant Date S C.f mixture containing a hazardous material equal to or greater that the
amounts spe 'fred on the Hazardous Materials Information Guide?
WARNING:FAILURETO 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 or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant requires permit for the construction or modification from South
IN SECTIONON
3 THE COST LABOR CODE,INTERDAMA D ATTOS AS RNEYS
EYSFEES
FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECilON 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY n Yes —d6a
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 Illy—No
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 my require under the State of
Contractors License Law for the reason(s)indicated below by the California Healt Sa de,Section and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous eria rting.
Business and Professions Code).Any city or county that requires a permit to N*es o
construct,alter,improve,demolish or repair any structure,prior to its Date L S L
issuance,also requires the applicant for the permit to file a signed statement ROPERTY OWNER OR AUTHORIZED AGENT
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($S00). managers who do the paint-disturbing work themselves or through their
D 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.eo La�g_ov/lead/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 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. o No EPA Lead-Safe Certified Firm Is required for this project because:
o 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 RAP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER - (g
TYPE: [-]COMMERCIAL ,❑RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION []ELECTRICAL [:]MECHANICAL
❑NEW EZPLUMBING ❑RE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK .Pi- seLje.- (kn rivCi„JLt •
c ity of Menifee
PROJECT ADDRESS I -7 CC) - j-e Z_ ^Sr- 00 'r F11,11afet D pt.
ASSESSOR'S PARCEL NUMBER JI trja- �Qa'Wii LOT TRACT -
OWNER NAME {'r lGi l.r 1(13 e
ADDRESS p T7 C nrA<2 Ake CA E)ceive
PHONE �J`-( •' .Sy �- S�9(a EMAIL
APPLICANT NAME
ADDRESS e' Zr,Sj CA V$C7
PHONE 9S/ 31//93if EMAIL
CONTRACTOR'S NAME OWNERBUILDER? ❑YES NO
BUSINESS NAME
ADDRESS AO W e� �/C►r •q a,$I:J
PHONE _ ,'J�, /,fJ( G/�j`�� / EMAIL
CONTRACTOR'S STATE LIC NUMBER 51 ICENSE CLASSIFICATION e-
3�J
VALUATION$ pQ S -SC1 FT ! /
APPLICANT'S SIGNATURE DATE
5
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE i GREEN SMIP J�
INVOICE pglD AMOUNT
AMOUNT 119505
OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
3
�ec� PL
City of tAenifee
Building & Safety DePt.
SEP 0 5 2017
Fleceived
L Xi Sr ,C�c�le//rn�
,r
j Ae ,e Leif �.
Iwtt, °3.�r
CITY OF MENIFEE
MUDINGANDSAFETY DEPARTMENT
PLAN-APPROVAL
REVIEWED gY
DATE
approval
f these plans ;half not be construed to be a permit fa,Wan
any vl000n of any provisions of the federal,state ordty
jobsitetun�til compoes. This set of approved Plans
must be kept on the