PMT17-03961 City of Menifee Permit No.: PMT17-03961
29714 HAUN RD.
<ACCELA; MENIFEE,CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 1110 312 01 7
PERMIT
Site Address: 24865 SPRINGBROOK WAY, MENIFEE, Parcel Number: 341-240-014
CA 92584 Construction Cost: $1.950.00
Existing Use: Proposed Use:
Description of REPLACE 50 GAL GAS WATER HEATER IN GARAGE
Work:
Owner Contractor
ROBERT ROSAS A R S AMERICAN RESIDENTIAL SERVICES OF
24865 SPRINGBROOK WAY CALIFORNIA INC
MENIFEE,CA 92584 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9012719700
ANDREW ALLEN License Number:765155
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNU
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description 01tr - Amountl$
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 building 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_Peonit_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 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 Cl pQsi—f .l License No By my signature below l acknowledge that,except far my personal residence
Expires NI 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 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 370D of the Labor Code,for the performance of work for which www.IeRmfo.ca.Rov/caIaw.htmI.
this permit is issued.
Policy# Date
cave and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
4ectfan 3700 of the Labor Code,for the performance of the work for which 0 my signature below I certify to each of the fallowing:)am the property
this permit Is issued.My workers compensation insurance carrier and polity w>t" ner or authorized to act on the property owners behalf.1 have read this
number are application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and coun nances and state laws relating to
�a q� building co stru Iauth representatives of this city or county to
Policy# • �SII i A]!Expires enter th dentifi erty for inspection purposes.
(This section need not to be completed is the permit is flir one-hundred ^
dollars($100)or less OL Date
PROPERTY OWNER OR AUTHORIZED AGENT
.0-�Certify that In the performance of the work for which this permit is issued,
-I shall not employ any personin any mannerso to become subject to the CITY BUSINESS LICENSE#
workers compensation s of Cglt nia,a ree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the work comye/ ion ' ions of Section 3700 oftTic(
bor
Code,l shall fo ith �ii -wit rov ions. / Will the applicant or future building p[cupanthandlehatardous material ara
Applicant Date 6 mixture containing a hazardous material equal to or greater that the
amounts spe fled on the Hazardous Materials Information Guide?
WARNING:FAILURETO SECURE WORKER'S COMPENSATIO COVERAGE IS ❑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 modifiation from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)7 See permitting checklist
IN SECTION 3705 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY o Yes -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) ❑Yes I'd"10
OWNER BUILDER DECLARATIONS I have read the Hazardou aterial Information Guldeandthe SCAQMD
1 hereby affirm under penalty of perjury that I am exempt from the Permitting checklist. nder 'dmy require underthe State of
California H
Contractors License Law for the reason(s)indicated below by the ealt Safe de,Section and 255T4 concerning
hazardous erica rung.
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5
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 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 Contactors State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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 orthrough their
o I,as owner of the property,or my employee with wages as theirsole 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.aov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800424-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. 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.
& SAFETY PERM IT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER '
TYPE: ❑COMMERCIAL RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL
[-]NEW MPLUMBING [:IRE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK ]QC,e 4L ( VIeQ r
PROJECTADDRESS aLi g(P J )Prtno bro0 LJZL
ASSESSOR'S PARCEL NUMBER .a-�y'�I�'�-- LOT TRACT o YJv
OWNER NAME Robe-r*-
ADDRESS CA
PHONE qC1 (o01 EMAIL
APPLICANT NAME i. v\ MWN
ADDRESS a0 W LIVE P.V1 5k Ive sid< CA gD-07
PHONE 51 -64 I ; 3-1 ( EMAIL
CONTRACTOR'S NAME $Gut V=o -r OWNERBUILDER? ❑YES ONO
BUSINESS NAME E
ADDRESS o
//��
PHONE `7�J I ' CLl ( q-�,-71 EMAIL
CONTRACTOR'S STATE LIC NUMBER (SS LICENSE CLASSIFICATION L.'3
VALUATION$ ('150 S LSQFT
APPLICANT'S SIGNATURE / - DATE 1 I 1
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ' SMIP
INVOICEAMOUNT 11�•17 PAID AMOUNT
O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER 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 951-246-6213
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