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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. 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