PMT17-04078 City of Menifee Permit No.: PMT17-04078
29714 HAUN RD.
<-1-�CCELf-> MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 1111412017
PERMIT
Site Address: 26114 FOUNTAIN BLEU DR,MENIFEE, Parcel Number: 337102025
CA 92586 construction Cost: $5,500.00
Existing Use: Proposed Use:
Description of INSTALL NEW 3"SEWER LINE AND CLEANOUT
Work:
Owner Contractor
MARY AN WEIGNER A R S AMERICAN RESIDENTIAL SERVICES OF
26114 FOUNTAIN BLEU DR CALIFORNIA INC
965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9 01 271 9700
ANDERW ALLEN License Number.765155
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIU
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS,CA 38120
Fee Description O_yt Amount($)
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 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_Pennit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who ilds or improves thereon,and who contracts for the projects
with nsed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisio
Chapter9(commencing with section 7000)of Division 3 of t " ess and ,'❑I am exempt from Iicensure under the Contractors State License Law for
Professions Code and my license is in full force and e %" the following reason:
License Cla ((�� Lice J/ By my signature below l acknowledge that,except for my personal residence
Expires-1/JI Signatu , ' inwhichl must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION 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.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.leeinfo.ca�ov/calaw.html.
this permit is issued.
Policy# Date
__wI�ve 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 ;6 By my signature below l 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 prgpe
iqPwner's behalf.I have read this
number are: y[ application and the informati a rovi e0is correct.I agree to comply
�-� /'7 with all applicable city co ord �nd state laws relating to
Carrier I - (( building constru .I onz� r�ntatives of this city or county to
Policy# "l Expires enter the ah tifie pe .f rinspection purposes.
This section need not to be completed is the e t s ne-hundred i. Date 1 I
dollars($100)or less ' PROPER O R OR A RIZED AGENT
❑I certify that in the performan of e� 'or which this permit is issued,
Ishallnotemol�_y any pers i ny rp so as to became subject to the CITY BUSINESS LICENSE#
workers compensatio a f C I and agree that if I should become
subject to the wa r p �o provisions of Section 3700 of the labor HAZARDOUS MATERIAL DECLARATION
Code,I shall f w' with hose provisions. ^ Will the applicant or future building occupant handle hazardous material or a
Applica Date mixture amounts specified
iedonng a he Hazus ardous
rial Materials
to Information
that the
amounts specffled on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes o7 Ho
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($500,000),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)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCNON LENDING AGENCY ❑Yes qrNo
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 bouydary of a school?
(Section 3097 Civil Code) ❑Yes NO
OWNER BUILDER DECLARATIONS I have read the Hazardous M nformation a and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I u nd my requir is under the State of
Contractors License Law for the reason(s)indicated below by the California Health& Code,SecOori' 5 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes o ma ing.
Business and Professions Code).Any city or county that requires a permit to ❑Yes ❑ rn
Date
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(RRP)
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($500). managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.Rov/lead or contact the National Lead Information Center at
not Intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the Improvements are not intended or offered for Certified Fjrm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATIONF
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: []ADDITION [—]ALTERATION ❑DEMOLITION []ELECTRICAL ❑MECHANICAL
❑NEW PLUMBING ❑RE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK )VA\\ j\009`` Or-, CL.-)C e-
PROJECTADDRESS wIl Neu •r
ASSESSOR'S PARCEL NUMBER 33) - joa- OaS' LOT TRACT
OWNER NAME f An Vie I C . e
ADDRESS PU Sun GI cj d-S
PHONE 961-J() - Li$S-) EMAIL
APPLICANT NAME Av)Jaw yA lle
ADDRESS Sib W IVIderr 51- ivi,�dCA IRRLSD?
PHONE �J�� ' 541'/-�13 `.f ' EMAIL
CONTRACTOR'S NAME /'C PS Rescue goote✓ OWNERBUILDER? ❑YES NO
BUSINESS NAME
•`� fJ /�� 1
ADDRESS 7Ob vJ L-iVK.^e� Sf- Uevsid' CA j:sZ-
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER 5 I ENSE CLASSIFICATION C
VALUATION$ L SQ FT
APPLICANT'S SIGNATURE DATE I I
. cf' _
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMP
INVOICE PAID AMOUNT
AMOUNT CASH vCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES O NO
City of Menifee Building& Safety Deportment 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofineni fee.us Inspection Request Line 951-246-6213
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BI IILDING AND SAFETY DEPARTMENT
PI AN APPROVAL.
R VIEWED BY
,DATE
N *Approval of these plans shall not be construed to ce a
a,provai of,any violation of any provisions of the federal,state or city
I regulations and ordinances. This set of approved plans must be kept on the
\ jobsite until completion.
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