PMT17-03879 City of Menifee Permit No.: PMT17-03879
29714 HAUN RD.
�!-�CGEL/1� MENIFEE,CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 10/30/2017
PERMIT
Site Address: 24451 CONEJO DR, MENIFEE,CA 92584 Parcel Number: 341-170-030
Construction Cost: $6,200.00
Existing Use: Proposed Use:
Description of REPLACE CLEANOUT AND 20 FT SEWER LINE.
Work:
Owner Contractor
LISA WILSON A R S AMERICAN RESIDENTIAL SERVICES OF
24451 CONEJO DRIVE 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
Phone:9513419371
Fee Description Qtv Amount($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 underwhich 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 forthe projects
I hereby,affirm under penalty of perjury 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 D I am exempt from licensure 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
QQ By my signature below I acknowledge that,except for my personal residence
Expires 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
o l 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 websile:
by Section 3700 of the Labor Code,for the performance of work for which www,leeinfo.a�ov/calaw.html.
this permit is issued.
Policy If Date
'�Lhrave and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
4ection 3700 of the Labor Code,for the performance of the work for which 0 m/y signature below I certify to each of the fallowing:I am the property
this permit is issued.My worker a`"s compensation insurance carrier and policy w ner Or 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 with all applicable city and court nances and state laws relating to
�a building co stru .I auth representatives of this city or county to
Policy# " 4 I Expires enterth dentin erty for inspection purposes.
(This section need not to be completed is the permit is f tune-hundred ^ �C,
Date
dollars($100)or less
PROPERTY OWNER OR AUTHORIZED AGENT
,�Cerify that in the performance of the work for which this permit is issued,
1 shall not employ any persc in any manner s W to become subject to the CITY BUSINESS LICENSE#
workers compensation s of I' ma,a ree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the work s com ion .ions of Section 3700 of th Labor
Code,I shall fo it -wit o rov, ions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date 6/ (f mixture containing a hazardous material equal to or greater thatthe
amounts spe 'tied on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE IIORKER'SCOMPENSATIO COVERAGEIS ciYes 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 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY crYes �o
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) 0 Yes 11c,"No
OWNER BUILDER DECLARATIONS I have read the Hazardou atertai 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
California Healt Safe de,Section and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous eria rting.
checkmark(s)1 have placed next to the applicable item(s)(Section 7031.5 �� a
Business and Professions Code).Any city or county that requires a permit to Date s
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 RENOVATION.REPAIR AND PAINTING(RRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RAP)Rule requires contactors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs painlin 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($500). managers who do the paint-disturbing work themselves orthrough their
01,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800.424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not Intended or offered for Certified Firm Name:
sale.If,however,the building or improvement Is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. in No EPA Lead-Safe Certified Firm Is required for this project because:
❑1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
PERMIT/PLAN& SAFETY APPLICATION
Menifee
DATE 19 130117 PERMIT/PLAN CHECK NUMBER I — )
TYPE: ❑COMMERCIAL RESIDENTIAL [-]MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: [:]ADDITION []ALTERATION []DEMOLITION []ELECTRICAL El MECHANICAL
❑NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK O In o 0 I/ 11 NG
PROJECTADDRESS y) () )(- - I c J U
ASSESSOR'S PARCELNUMBER 31-f- �.���. DSO LOT TRACT
OWNERNAME Lisa, WI on ADDRESS HL rS\ COIl1G' O D•( )1 Fee CA 571 aSBl
PHONE �31$• 29H- QC(3� EMAIL
APPLICANT NAME A d{ew gg A I If 17
ADDRESS jf;,,Cj W LoACV) 5�- fl1Vl.I5 CA SZ-7
PHONE . qSl 3q{ -r';71 EMAIL
CONTRACTOR'S NAME S VeScot 0 ✓ OWNER BUILDER? ❑YES NO
BUSINESS NAME
ADDRESS ap e 1 JQ(S e 6A SSP7
PHONE R,51 3Lt1 1 EMAIL
CONTRACTOR'S STATE LIC NUMBER ' ICENSECLASSIFICATION 63(O
VALUATION$ 51�17y S.Q-FF L SQ FT
APPLICANT'S SIGNATURE DATE I O 13V I(1 -7
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS UCENSEJdUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP V
INVOICE AID AMOUM
AMOUNT • OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES 0 NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 925E6 9]3U11�11R9'DePt•
www.cityofinenifee.us Inspection Request Line 951-246-6213
OCT 3 U 1011
Received
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CITY OF MENI EE
BUILDING AND SAFETY DEPARTMENT rQuarP�
PLAN APPROVAL
REVIEWED. io • o3o• n
DATE
'Approval of these plans shall not be construed to be a permit for,or an City Building Dept.
Ni ept.
approvalA,any violation of airy provisions of the federal,state 6r dty
regolatiom and ordinances. This set of approved pilan�iilst be kept on the OCT 3 0 2011*1i 7
icisite until completion:
Received