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PMT17-03612 City of Menifee Permit No.. PMT17-03612 29714 HAUN RD. �CCELA? MENIFEE,CA 92586 Type: Residential Plumbing MENIFEE Date Issued: 1 0/1 012 01 7 PERMIT Site Address: 26972 CHAMBERS AVE, MENIFEE, CA Parcel Number: 335-323-002 92586 Construction Cost: $4,224.00 Existing Use: Proposed Use: Description of INSTALL 3"DUAL SWEEP CLEANOUT ON SEWER LINE Work: Owner Contractor LINDA EDGMON A R S AMERICAN RESIDENTIAL SERVICES OF 26972 CHAMBERS AVENUE CALIFORNIA INC MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201 Applicant Phone: 9012719700 A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORN6 License Number: 765155 965 RIDGE LAKE BLVD SUITE 201 MEMPHIS,CA 38120 Phone: 9012719700 Fee Description Qtv Amount ISI Sewer 1 150.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Plumbing 1 7.50 $186.50 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_Permlt_Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractors)pursuant to the Contractors State License law). Chapter9(commencing with section 7000)of Division 3 of the Business and oj_grn exempt from licensure under the Contractor's State License Law for Professions Cade and my license is in full force and effect a fallowing reason: License Class v1�1 License No. By my signature below I acknowledge that,except for my personal residence Expires i l Signature in which I must have resided for at least one year prior to completion of WORKER'S COMPENSATION DECURATI N improvements covered by this permit.I cannot legally sell a structure that I 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.1 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.leainfo.ra eov/calaw html. this permit is issued. Policy R Date have and will maintain workers 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 1 certify to each of the following:I am the property this permit Is Issued.My workers compensation Insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this numberare: application and the information I have provided is correct.I agree to comply Carrier VU ' ( S with all applicable city and co u in and state laws relating to ''�11''��I qr r� building construction.I z sentatives of this city or county to Policy g Qk I��1W� Expires AO I % I ( V enter the above' a ertyfor inspection purposes. (This section need not to be completed Is the permit is for one-hundred dollars($100)or less Date PROPERTY OWNER OR AUTHORIZED AGENT ❑I certify that in the performance of the work for whit his permit is issued, I shall not emolov any persons in any mann ecome subject to the CITY BUSINESS LICENSE p workers compensation laws of Cali aad agree t if I should become HAZARDOUS MATERIAL DECLARATION subject to the workers com provisi of Section 3700 of the Labor Cade,I shall forthwit ith t rovisions. Will the applicant or future building occupant handle hazardous material or a Applicant Date 0 0 mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ANo 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 for guidelines CONSTRUCTION LENDING AGENCY ❑Yes cr No 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 Cade) ❑Yes ofTa OWNER BUILDER DECLARATIONS I have read the Hazardous Material formation Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I underm irements under the State of Contractors License Law for the reason(s)indicated below by the California Health&Sa o ion 25505 and 25534 concerning hazardous mat ' e checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ryes oflC Business and Professions Code).Any city or county that requires a permit to Date O b construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER 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(RRPI License law(Chapter 9(commencing with Section 7000)of Division3 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 apre-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 than 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,oT 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.aov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-80D-424-LEAD(5323). Code,The Contractors State License Law does not apply to an owner of a ❑ property who,through employees'or personal effort,builds or improves the An EPA Lead-Safe Certified Renovator will be responsible for this project 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. & SAFETY PERMIT/PLAN CHECK APPLICATION Menifee DATE 0-/0-'1 7 PERMIT/PLAN CHECK NUMBER �O TYPE: ❑COMMERCIAL ORESIDENTIAL [-]MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION []ELECTRICAL El MECHANICAL ❑NEW PLUMBING [I RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK t ( dual -)wee-o c_jeAfo.,,4I`- ON Se'wt �IKL r PROIECTADDRESS ! ' (o q -7 D., C V\a VA& -�beir /� ASSESSOR'S PARCEL NUMBER 33 5 '3 a3,opd-) Q TRACT CO OWNER NAME��77 �Y"1 06'. W` Y-\ of ADDRESS &'J Da v O ( J T PHONE 762 ?j- S00 - S%S(o EMAIL APPLICANT NAME lets ADDRESS / 1,,6;C6 k / S-F Ur;>e5 i0e; 1!::, � %-�PHONE / 31-/( 'JT37f EMAIL CONTRACTOR'S NAME 'QS PSGUC OWNERBUILDER7 ❑YES NO BUSINESS NAME ADDRESS 5 V PHONE 3 71 EMAIL CONTRACTOR'S STATE LIC NUMBER &S�/ LICENSE CLASSIFICATION VALUATION$ % Z Z�/ �5 / L SO FT APPLICANT'S SIGNATURE / DATE TYSTAFFUSEONLY Aim" DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP �✓ ✓�� INVOICE AMOUNT ' ID AMOUNT ;;CASH GCHECK# GCREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT GCASH GCHECKq GCREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZED LETTER YES 0 NO City of Menifee Building&Safety Deportment 29714 HDLIn Rd. ivienifee, CA 82 ti8gfiA ��e6777 www.cityofinenifee.us Inspection Request Line 951-2 � & Safety Dept. OCT 10 201, Rece' ed IV `` ' vi dugl 5L�ecP 1r Ue�,rn:.F 1 • FW— 311 Z dg W n E Q o FSONt PL W v a o Q 0 Csr W g ? N u- o Q = _ t v�, be W `" Q 6�a N LL. p Z Z O co W Q p a s o c rl W City of Menifee O Q Building & Safety Dept, o i = Q W a s OCT 10 2017 v cc m cc T o Received