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PMT17-03541 City of Menifee Permit No.: PMT17-03541 29714 HAUN RD. 'lACCEL/Q? MENIFEE, CA 92586 Type: Residential Plumbing MENIFEE Date Issued: 10/04/2017 PERMIT Site Address: 28358 SADDLECREST ST, MENIFEE, CA Parcel Number: 333312-001 92585 Construction Cost: $2,300.00 Existing Use: Proposed Use: Description of REPLACE 50 GAL GAS WATER HEATER IN GARAGE Work: Owner Contractor KATHLEEN HENNESSY A R S AMERICAN RESIDENTIAL SERVICES OF 28358 SADDLECREST ST CALIFORNIA INC MENIFEE,CA 92585 965 RIDGE LAKE BLVD SUITE 201 Applicant Phone:9012719700 ANDREW ALLEN License Number:765165 A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIt 965 RIDGE LAKE BLVD SUITE 201 MEMPHIS, CA 38120 Fee Description Oft Amount 151 Residential Water Heater 1 83!01) 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_Permil_Template.rot Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects Ihereby,affirm under penalty of perjury that lam under provisions of with a licensed cantrector(s)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and o 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: License CI License No By my signature below I acknowledge that,except for my personal residence Expires N 1 QQff Signature In which I must have resided for at least one year priorto 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 ❑1 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 www.Ieginfo.ca.goy/caIaw.htmI.permit is issued. Policy# Date E�Lhave and will maintain worker's compensation Insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT £ection 3700 of.the Labor Code,for the performance of the work for which o mysignature below I certify to each of the following:I am the property this permit is issued.My workers compensation insurance carrier and policy wner or authorized to act on the property owners behalf.I have read this number are application and the information I have provided is coned.I agree to comply ,r �VuC with all applicable city and coun nances and state laws relating to Carrier �g building stru .Iauth representatives of this city or county to 4S(/Policy# ^ Expires enter th dentifr arty for inspection purposes. (This section need not to be completed is the permit is f r one-hundred Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT ,glertify that in the performance of the work for which this permit Is issued, I shall not am Ploy any perso in any manner sW to become subject to the CITY BUSINESS LICENSE# workers compensation s of C 1' ma,a ree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the woe sc7p ion ons ofSecd 3700 ofth Labor Cade,I shall fo f rfi -wit o rov ions. Will the applicant or future building occupant handle hazardous material or a Applicant Date �.( mixture containing a hazardous material equal to or greater that the amounts spa feed on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATIO COVERAGE IS oYes dNo 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($300,000),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 o Yes -0�Nci 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) o Yes ir�`No OWNER BUILDER DECLARATIONS I have read the Hazardou aterial Information Guideand the SCAQMD I hereby affirm under penalty of perjury thatlam exempt from the permitting checklist. nde myrequire under the State of Contractors License Law for the reason(s)indicated below by the California Heal Safe de,Section and 25534 concerning h/azardous aria rting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 A*� o ,f 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 ROPERTYOWNER 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 Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRP) License Law(Chapter9(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($500). managers who do the paint-disturbing work themselves or through their o I,as owner of the property,or my employee with wages as their sole employees.For more Information about EPA's Renovation Program visit: compensation,will do( I all of or( )portion of the work,and the structure is wwW.ena.Fmy/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323). Code,The Contractors State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project property who,through employees'or personal effort,builds or improves the property provided that the improvements are not Intended or offered for Certified Firm Name: sale.If,however,the building or Improvement Is sold within one year of Firm Certification No.: completion,the Owner-Builder will have the burden of proving that it was not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because: o I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP role please RII out the RRP Acknowledgement. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION Menifee DATE PERMIT/PLAN CHECK NUMBER I�'O TYPE: [—]COMMERCIAL O RESIDENTIAL MULTI-FAMILY ❑MOBILE HOME POOL/SPA []SIGN SUBTYPE: ❑ADDITION []ALTERATION [—]DEMOLITION []ELECTRICAL ❑MECHANICAL ❑NEW ©PLUMBING [:]RE-ROOF-NUMBEROFSQUARES DESCRIPTION OF WORK ge 4 Ge 5­0 o Q A t.r' kgfA4-e,— I v--\ a T,0 e PROJECTAD ESS ASSESSOR'S PARCEL NUMBER 'bV775 3%0M I LOT TRACT OWNER NAME v.✓Te S$ ADDRESS es+ Sfi mo\a v CA sS�S PHONE 711 U EMAIL APPLICANT NAME ADDRESS o 21'�7 PHONE �j I �� t cj-7 -7 EMAIL CONTRACTOR'S NAME OWNERBUILDER? DYES[/NO BUSINESS NAME ADDRESS �] -odc,- W ✓jgCN ✓ 1 e CA 93-d7 PHONE -L S 1 ( Cj�j I EMAIL i CONTRACTOR'S STATE LIC NUMBER 7Co Sl LICENSE CLASSIFICATION C 3� VALUATION$ 2 3 D' L SQ FT APPLICANT'S SIGNATURE DATE r;BM" s DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP INVOICE PAID AMOUNT AMOUNT I'�' OCASH C%CHECK# 'CREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT ("CASH OCHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES G NO City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-572-6777 www.cityofinenifee.us inspection Request Line 951-246-6213 Z ram+ m ° `2 `L o. 4� n '^ T v r) m�7 y yy m p a O T No m N m �Z d N a wQa6. 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