PMT17-04329 City of Menifee Permit No.: PMT17-04329
29714 HAUN RD.
�CCEL A MENIFEE,CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 12/07/2017
PERMIT
Site Address: 28652 PEBBLE BEACH DR, MENIFEE, Parcel Number: 337-222-024
CA 92586 Construction Cost: $2,660.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE 40G GAS WATER HEATER-SAME SIZE, SAME LOCATION
Work:
Owner Contractor
GEORGE MOSER A R S AMERICAN RESIDENTIAL SERVICES OF
28652 PEBBLE BEACH DRIVE CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD#201
Applicant Phone:9012719700
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNb License Number.765155
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
Phone:9513419371
Fee Description gy Amount f81
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_81dg_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 hereby,affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractor State License taw).
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 ' ✓an License No
qq By mysignature below I acknowledge that,except formypersonal residence
Expires H Signature in which I must have resided for at least one year priorto completion of
improvements covered by this permit.I cannot legally nil a structure that 1
WORKER'S COMPENSATION DECLARATION
have hail[as an owner-builder if it has not been constructed in Its entirety by
01 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.Ieginfia.ca.zav/caIaw.html.permit Is Issued. sv
Policy# Date
,75L 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 o�S/mysignature below I certify to each of the following:i am the property
this permit is issued.My workers compensation insurance carrier and policy w6 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 withal]applicable city and coun manes and state laws relating to
�g buildingc tru loath representatives of this city or county to
Policy# - a l Expires enter th dentifi erty for inspection purposes.
(This section need not to be completed is the permit is f tune-hundred Date /4
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
�ertffy that in the performance of the work for which this permit is issued,
-I shall not employ any perso in any mannersW to become subject to the CITY BUSINESS LICENSE#
workers compensation ofC li ma,a ree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the work com e�ion "sons of Section 3700 ofth Lobar
Code,Ishall fo ith Fn •w, rov ions. / Will the applicant or future building occupant handle hazardous material or
Applicant Date 6 C.( mixture containing a hazardous material equal to or greater that the
amounts spe fled on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSAT10 COVERAGE IS 0 Yes No
UNLAWFUL,AND SHALLSUBSECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building bythe 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 forguidel�ines
CONSTRUCTION LENDING AGENCY r Yes
I herebyaffirm that underthe penalty of perjurythere is a construction Willthe proposed building ormodified facility Iewithin1000 feetof 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 1-d'N-o
OWNER BUILDER DECLARATIONS I have read the Hazardou aterial Information Guide and the SCAQMD
I herehyaffirm under penalty of perjurythat I am exempt from the permitting checklist. nder�a'dmy require under the State of
Contractors License Law for the reason(s)Indicated below by the hazzaCalif ounia Healt Saf de,Section and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 h//azardous erica rting.
Business and Professions Code).Any city or county that requires a permit to �*es 0
Date
construct,after,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(RRP)
License Law(Chapter9(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 Ifcensure receiving compensation for most work that disturbs paintin 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
cz 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.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered far 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 0 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. 0 No EPA Lead-Safe Certified Firm Is required for this project because:
a 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 APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER T"TI� V ��
TYPE: ❑COMMERCIAL EIRESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION [-]DEMOLITION [-]ELECTRICAL ❑MECHANICAL
❑NEW ®PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK (pCe
PROJECTADDRESS 0( (o5a b le eac,1„ { Gl"oL�j SIP
ASSESSOR'S PARCEL NUMBER •aa� . Day- LOT TRACT
OWNER NAME CC�� Geo roe w r
ADDRESS 8(QJreW
n p(
PHONE _ISI_ _/4U_ $OyI✓ EMAIL
APPLICANT NAME E ew)
ADDRESS Sao Q L11h eNM .54- (�A 619$-0-7
PHONE q_5I- a>-,j [- q EMAIL
CONTRACTOR'S NAME Q? OWNERBUILDER? ❑YES®NO
BUSINESS NAME II
ADDRESS I's-D 0 W L IV10Pet--, �t- fz��/C r � ( ag0 -
PHONE 4'S 13 Lk 1 1 3-7 EMAIL
CONTRACTOR'S STATE LIC NUMBER -7(p S- S S LICENSE CLASSIFICATION C Co
VALUATION$ DSO L SO FT
APPLICANT'S SIGNATURE DATE A
All
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP V
INVOICE f i i r PAID AMOUNT ✓
AMOUNT v ''I� OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O 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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