PMT17-03664 City of Menifee Permit No.: PMT17-03664
29714 HAUN RD. Type: Residential Plumbing
d"ACCELh? MENIFEE, CA 92586 yp g
MENIFEE Date Issued: 10/12/2017
PERMIT
Site Address: 26091 PORT RUSH DR, MENIFEE, CA Parcel Number: 337-132-002
92586 Construction Cost: $1,625.00
Existing Use: Proposed Use:
Description of REPLACE 40 GAL GAS WATER HEATER IN HALLWAY
Work:
Owner Contractor
HENRY STEMMANN A R S AMERICAN RESIDENTIAL SERVICES OF
26091 PORT RUSH DRIVE CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9012719700
ANDREW ALLEN License Number:765155
A R S INC DBA RESCUE ROOTER
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Oyt Amount I51
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 carded 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
I herebyaffirm 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 o I am exempt from Iicensure under the Contractors State License Law for
Professions Code and my license Is in full force and effect the following reason:
License CI License No J
qqf By my signature below I acknowledge that,except for my personal residence
Expires 91 Signature inwhich l must have resided for at least one year priorto completion of
improvements covered by this permit.I cannot legallysell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
o 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 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.IeRinfo.ca.gov/caIaw.htmI.permit is Issued.
Policy# Date
LyLhave and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZEDAGENT
ection 3700 of the Labor Code,for the performance of the work for which o my signature below l certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and polity er r authorized to act on the property owners behalf.I have read this
number are application and the information 1 have provided is correct.I agree to comply
with all applicable city and coun nances and state laws relating to
Carrier bWcstru .I oath representatives of this city or county to
Policy# ? �� Expires etifi erty for inspection purposes.
(This section need not to be completed Is the permit is r one-hundred Date WIG
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT
/01-certify that in the performance of the work for which this permit is issued,
-Ishallnotemulov any perso In any manner sW to become subject to the CITY BUSINESS LICENSE#
workers compensation s of C I' nia,a ree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the wor com ion ' ionsof5ection3700 ofth Labor
Code,I shall fo i[h -wit ov ions. / Will the applicant or future building occupant handle hazardous material or a
Applicant Date 6 �.{ mixture containing a hazardous material equal to or greater that the
amounts spe Pied on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATIO4 COVERAGE IS o Yes No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant orfuture 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 guldelinq s
CONSTRUCTION LENDING AGENCY o Yes --dNo
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 IeRo
OWNER BUILDER DECLARATIONS I have read the Hazardou aterial Information Guide and the SCAQMD
I hereby affirm under penalty of perjurythatlam exempt from the permitting checklist. note my require under the State of
Californian Healt Saf de,Section and 25534 concerning
Contractors License Law for the reason(s)indicated below by the h�azardous eria rting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 �vres o Q I
Business and Professions Code).Any city or county that requires a permit to Date L (.
construct,alter,improve,demolish or repair any structure,prior to its ROPERTY 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 IRRPI
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 Iicensure 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.eua.eov/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 in 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 rule please fill out the RRP
Acknowledgement.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
Menifee
DATE /°I/t t7 PERMIT/PLAN CHECK NUMBER - neapuLA
TYPE: ❑COMMERCIAL RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA [:]SIGN
SUBTYPE: ❑ADDITION []ALTERATION [-]DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑NEW PLUMBING ❑RE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK 'e H U ct I U S 'F'L'✓ Y 1Pa'fP✓-
v, n+-e✓io�r ��Jp CltyofMenifeS-C
pt.
PROJECTADDRESS lq ,{-v- y^ 00 VELJ OCT 1120
ASSESSOR'S PARCEL NUMBER 35-1- 4?�-e-jSQ LOT TRACT
OWNER NAME P.{n IR, girt 1 vs
e ivei
ADDRESS BOO I O(�'�`( �� � C ('1' c� 1 sgo
PHONE �is-t (o7q Ja73 EMAIL
APPLICANT NAME y4cx,,a la-1lev,
ADDRESS 6 w LmAr 2- jglVer,5th
PHONE 9`57 .31193 7/ EMAIL
CONTRACTOR'S NAME S eswe.. J-'�'�'er OWNERBUILDER? ❑YES/eNO
BUSINESS NAME ADDRESS 50? whr S�(- O LI lh- CA -�
PHONE g,s-i 3 yi 13 ✓J EMAIL
CONTRACTOR'S STATE LIC NUMBER / LICENSE CLASSIFICATION
VALUATION$ 1(9�5 S �� LSQ FT
APPLICANT'S SIGNATURE DATE L^ i
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP X
INVOICE AMOUNT I�S•1.J PAID AMOUNT I�^•
i>CASH O CHECK# CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH 0CHECK# OCREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd, Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-5213
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