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PMT17-03735 City of Menifee Permit No.: PMT17-03736 29714 HAUN RD. ggWXCELA-> MENIFEE,CA 92586 Type: Residential Plumbing MENIFEE Date Issued: 1 011 812 01 7 PERMIT Site Address: 26160 FOUNTAIN BLEU DR, MENIFEE, Parcel Number: 337-102-021 CA 92586 Construction Cost: $2,493.00 Existing Use: Proposed Use: Description of REPLACE EXISTING GAS WATER HEATER,40 GAL Work: Owner Contractor HERMANNA LANDRY A R S AMERICAN RESIDENTIAL SERVICES OF 26160 FOUNTAIN BLEU DRIVE CALIFORNIA INC MENIFEE,CA 92586 965 RIDGE LAKE BLVD#201 Applicant Phone: 9512769744 CHRISTINA CALHOUN License Number:765074 A R S INC DBA RIGHTIME 965 RIDGE LAKE BLVD#201 MEMPHIS, CA 38120 Fee Description Qtv Amount($I 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 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_Pemvt_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 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 Contractor's State License Law for Professions Code and my license is in full force and effect. the following reason: License Class C(U C.ZO G3(0 L qse o. 5 0:3, By my signature below 1 acknowledge that,except for my personal residence Expires Q i Signature U in which i must have resided for at least one year priortocompletion 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 ❑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.Ieginfo.ca.gov/caIaw.htmI.permit is issued. Policy# Date ❑I 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 n By my signature below I 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 number are: 1— ,, �/ application and the information I have provided is correct.I agree to comply Carrier 1f�Cl'l With all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy#7(A119bPJ(.Oc� 01 ExpireS 1 enter the above identified property for inspection purposes. (This section need not to be completed is the permit is far one-hundred Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT o I certify that in the performance of the work for which this permit is issued, I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# workers compensation laws of California,and agree that if l should become HAZARDOUS MATERIAL DECLARATION subject to the workers compe tion ions of ection 3700 of the Labor Code,Ishall with an Ih s ow ' n Will the applicant or future building occupant handle hazardous material or Applicant Date 8 - mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNI AILURETO SECUR RKEWS COMPENSATION COVERAGE IS D 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 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 37060F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY o Yes Dko I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 10DO 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 blo 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 my requirements underthe State of Contractors License Law penalty offor the reason(s)Indicated belowrom by the California Health&MSafeCode,S n 2550 225534 concerning checkmark(s)I have placed next to the applicable Items)(Section 7031.5 haza us terialez ng. Business and Professions Code).Any city or county that requires a permitto D Z Date construct,alter,improve,demolish or repair any structure,prior to its R OWNER OR A OR2EDAGENT issuance,also requires the applicant for the permitto 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 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 ❑1,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.aov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAU(5323). Cade;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. o No EPA Lead-Safe Certified Firm is required for this project because: O 1,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 i� w. DATE %C) PERMIT/PLAN CHECK NUMBER TYPE: ❑COMMERCIAL &ESIDENTIAL MULTI-FAMILY ❑MOBILEHOME POOL/SPA [-]SIGN SUBTYPE: []ADDITION ❑ALTERATION ❑DEMOLITION []ELECTRICAL , MECHANICAL ❑NEW 9PLUMBING ❑RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK PROJECTADDRESS z, 1p� Q,v �' �oL ASSESSOR'S PARCEL NUMBER "�� 10a - 0a\ LOT TRACT Building &Safety DOI t. PROPERTY OWNER'S NAME rR�^( TV�,GbV'�Y10. 17 2017 ADDRESS �K^C+ 66'6 �c�Ncr5. t—C.-. PHONE WI 79 -1l090�j EMAIL e����� APPLICANTNAMEtr\ ADDRESS c...Tj ` ✓�L-7�<t"� PHONE (951) EMAIL C'-/ CONTRACTOR'S NAME �- �V7�C_ CPILLf. 'C,F ✓ C-OWNER BUILDER? ❑YES 7JNO BUSINESS NAM77E�� . fZ J . Q7 ADDRESS 3L„! PHONE S40 &(a -7 EMAIL CONTRACTOR'S STATE LIICNUMBER Z�S'o LICENSE CLASSIFICATION CID eCc G3 (P VALUATION$ 2- t'193 5 L SO FT APPLICANT'S SIGNATURE6 DATE .46 0TYSTAFFLISE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT C CASH CHECK K -'CREDIT CARD VISAIMC PLAN CHECK FEES PAID AMOUNT ^CASH 'CHECK 9 CREDIT CARD VISA/MC OWNER BUILDER VERIFIED (, YES C NO DL NUMBER NOTARIZED LETTER ' YES C NO Rd. Menrj t�rlur''.f Lines yy 1246-62.13 •r�i• NSA 7 z �' m � p � p � mm>m y fA d m m a » » » N � N Sm =. cr) CL m m Of�� Iry ad � Qlfa1f�pQ � � cxm m �� BN � O � z08r 6 sm 10 m d = G' 10 NO a? A, 3 o n o o w v a v n m o d a 0 3 �' g 0EF � 3 x m 5 v " m A U m 2 3 N � °� � „ ro 3 n- � o. to ba w •'0 S O v V O O x O N• m N .C. 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