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PMT17-04331 City of Menifee Permit No.: PMT17-04331 29714 HAUN RD. Type: Residential Plumbing �CCEL7 MENIFEE, CA 92586 MENIFEE Date Issued: 12/07/2017 PERMIT Site Address: 29834 PRELL CT, MENIFEE, CA 92584 Parcel Number: 340-404-012 Construction Cost: $1,975.00 Existing Use: Proposed Use: Description of REMOVE AND REPLACE 50G GAS WATER HEATER-SAME SIZE AND LOCATION Work: Owner Contractor DARYL MCCREARY A R S AMERICAN RESIDENTIAL SERVICES OF 29834 PRELL CT CALIFORNIA INC MENIFEE, CA 92584 965 RIDGE LAKE BLVD#201 Applicant Phone:9012719700 A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNP License Number.765155 965 RIDGE LAKE BLVD#201 MEMPHIS, CA 38120 Phone:9012719700 Fee Description ,q�t Amount I$) 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_Bldg_Perrrit_Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects I herebyaffirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law). Ch3pter9(commencing with section 7000)of Division 3 of the Business and D 1 am exempt from licensure under the Contractors State License Law for Professions Cade and my license is in full force and effect the following reason: License Clips 36 License No By mysignature below 1 acknowledge that,except foranypersonal residence Expires H qq1 IN Signature in which I must have resided for at least one year priortocompletion of improvements covered by this permit.I cannot legallysella 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 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 ofthe Labor Code,for the performance of work for which wvnv.leeinFo.ca.eov/mlaw.html. this permit is issued. Policy If Date ?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 D my signature below I certify to each of the following:I am the property this permit is issued.My workers compensation insurance carrier and policy water or authorized to act an the property owners behalf.I have read this number are application and the information I have provided is correct.I agree to comply Cartier M1 with all applicable city and coun mantes and state laws relating to ' '�gg buiidingc trio Iauth representatives of this city or county to Policy# •" oo I Expires. enter th dentifi erty far inspection purposes. (This section neednot to be completed is the permit is lirone-hundred Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT �certify that in the performance of the work for which this permit is issued, shall not employ any perso many manner sop to become subject to the CITY BUSINESS LICENSE# workers compensation s oFC It hie,a ree that if I should became HAZARDOUS MATERIAL DECLARATION subject to the war corn ionion ' tuns of Section 3700 ofth Lahor Cade,I shall to tth faa it o rov ions. Will the applicant or future building occupant handle hazardous material or a Applicant Date (T mixture containing a hazardous material equal to or greater that the amounts spe 'Pied on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATIO COVERAGE IS oyes No UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant at 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 37060F THE LABOR C0DE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY o Yes -il-No 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 Cade) Dyes I-eNo OWNER BUILDER DECLARATIONS I have read the Hazardou aterial Information Guide and the SCAQMD I hereby affirm under penalty of perjury that lam exempt from the permitting checklist nde my require under the State of Contractors License Law for the reason(s)indicated below by the hazardouornias Healt Saf de,Section and 25534 concerning checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous erica rung. / Business and Professions Code).Any city or county that requires a permit to j9T� 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 Contractors State EPA RENOVATION,REPAIR AND PAINTING fRRP) 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 licensure receiving compensation for most work that disturbs paint in a pre-1978 and the basis for the alleged exemption.Any violation of Section 70313 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 o I,as owner of the property,or my employee with wages as their sole employees.For mare information about EPA's Renovation Program visit: compensation,will do( )all of or( )portion of the work,and the structure is www.epa.eov/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 D 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 ofsale. D No EPA Lead-Safe Certified Firm is required for this project bemuse: 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. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION S. pp � I; Menifee DATE (o /7 PERMIT/PLAN CHECK NUMBERPMTI-� ._ 0 �� i TYPE: ❑COMMERCIAL []RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA []SIGN SUBTYPE: []ADDITION ❑ALTERATION []DEMOLITION ❑ELECTRICAL ❑MECHANICAL ❑NEW [:]PLUMBING ❑RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK Q i,9cC 60 a lave RS 41 1 L v� qj^,t PROJECT ADDRESS q v)3 I J� C+ ASSESSOR'S PARCEL NUMBER 'MBER "1 V(J -"I���" I - V 1 LOT TRACT OWNER NAME Qa M LC -r&ry ADDRESS A q L P-1-f c-+ /� PHONE `ISM - 0rJa- (, 5'DO EMAIL APPLICANT NAME A(l ADDRESS ev-) !.A gD-Cv7 PHONE 5 Z�\ N -13o I EMAIL CONTRACTOR'S NAME Q cam. TZv- OWNERBUILDER? ❑YES©NO BUSINESS NAME ��77 ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION C� VALUATION $ L SQ FT APPLICANT'S SIGNATURE DATE 2 l 9 CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION I CIN OF tNIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREE ` SMIP �ll/I V/ INVOICE I/�� PAIDAMOUNT n CASH OCHECKtt QCREDIT CARD VISA/MC I ' I � I PLAN CHECK FEES PAID AMOUNT <; CASH OCHECKM OCREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES C NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building& Safety Department 29714 Houn Rd. 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