PMT18-00978 City of Menifee Permit No.: PMT18-00978
29714 HAUN RD. Type: Residential Plumbing
�CCEO/ MENIFEE, CA 92586
sM MENIFEE Date Issued: 0 3/0 512 01 8
PERMIT
Site Address: 26864 CHAMBERS AVE, MENIFEE, CA Parcel Number: 335-323-008
92586 Construction Cost: $2,100.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE 40G ELECTRIC WATER HEATER REPLACEMENT
Work:
Owner Contractor
MARIAN STOUVENEL A R S AMERICAN RESIDENTIAL SERVICES OF
26864 CHAMBERS AVE CALIFORNIA INC
MENIFEE,CA 92586 965 RIDGE LAKE BLVD#201
Applicant Phone:9512769744
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNI) License Number.765074
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
Fee Description ,city Amount ISl
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 emars in the plans and
specifications or from preventing builiding operations being carded 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_Permil 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 contractors)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Divislon 3 of the Business and O 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 Oasr 6'LtoCZ o 7G 3/,p—Licens No. lea 7`r 3y my signature below I acknowledge that,except for my personal residence
Expires [__ N'A_Iignature_ in which l must have resided for at least one year prior to completion of
W TT f WORKER'S COMPENSATION DECLARATI improvements covered by this permit.I cannot legally sell a structure that 1
ON
have built as an owner-builder if it has not been constructed in its entirety by
f,I hereby affirm under penalty of perjury one of th,rollowing declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent ofseif-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 tabor Code,for the performance of work for which
this permit is issued. vrcnv.leginfo.ca.aov/mIaw.html.
Policy If Date
❑I 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 ❑By 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 owner 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_ L—t*�_ � withal]applicable city and county ordinances and state laws relating to
l ;`� )'_ j j building construction.I authorize representatives of this city orcounty to
Polic # 7E3 iJ�� b:i1- �f 7 ' 1{�I, /)
Y � � enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hun red Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued, �+ J 7
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should becomeFhe
RDOUS MATERIAL DEClARA710N
subject to the workers compensation provisions of section 3700 of the Labor
Code,I shall fcthwith IFE-:01--
th th..se Provisions. the arni icant or future building occupant handle hazardous material or a
(., . jre containing a hazardous material equal to or greater that the
ApplicantDale unts specified on the Hazardous Materials Information Guide?
WARNING:F...wRE TO o wMPENSATION COVERAGE IS es .�UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIESthe intended use ofthe building by the applican[Pr future building
AND GVIL FINES UP TOONE HUNDRED THOUSAND DOLLARS($100,000J,INpant requires permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR t Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES tAir Quaines
CONSTRUCTION LENDING AGENCY s .a,NoI hereby affirm that under the penalty of perjury[here is a construction the proposed building or modified faclity be within 1000 feet of the
lending agency for the performance of the work which this permit is Issued r boundary of a school?(Section 3097 Civil Code) s D�OWNER BUILDER DECLARATIONS e read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the itting checklist.I understand my requirements under the State of
Contractors License Law for the masons)indicated below by the ornia Health&Safety Code,Section 25505 and 25534 concerning
rdous material reporting. p -y
checkmark(s)I have placed neat to the applicable items)(Section 7031.5 O No f\ 14617
{+y/r fBusiness and Professions Code).Any city orcounty that requires a permit to _Date (/ 4 I
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR ORIZEDyx�vr
Issuance,also requires the applicant for the permit to rile a signed statement C
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION.REPAIR AND PAIMrNG(RRP)
License Law(Chapter9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRPJ Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint ins pre-1978
andthecasts for the allegedexemption.Anyviolation it Section of not o residence or childcare facility to be RRP-certified firms and comply with
than
Applicant forapermit subjects the applicant tnacivil 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.eoa.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 O An EPA Lead-Safe Certified Renovator will he 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. ❑No EPA Lead-Safe Certified Finn 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.
i
' 1
DATE 3 �5�� PERMIT/PLAN CHECK NUMBE I%
TYPE: O COMMERCIAL Z RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: C ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW XFLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK o r,LiorRI L U.1/q
PROJECTADDRESS L. a 6/1 '� �C �� ��W
ASSESSOR'S PARCEL NUMBER _/5 'r '✓23J . • OT TRACT
OWNER NAME fv/�}l/0'R� , STlo%I\Ift\fEL
ADDRESS 0 b �l`�1'(�tFl`s �/rtL
PHONE:
5U_2 (/ ( EMAIL
APPLICANT NAME �n fl
ADDRESS �� ST • R�U Eks,of:- CpI, 1250
PHONE (M()) 60'Q67S EMAIL [r
CONTRACTOR'S NAME ` 11" �T Im ��� JT-�Ul OWNER BUILDER? O YES /, NO
BUSINESS NAME
ADDRESS (7 5C� (`A'YF1LS j 11`v f��ii✓I� Ga llj�3
PHONE g�� EMAIL
CONTRACTOR'S STATE((LIC NUMBER 5 V ti L I LICENSE CLASSIFICATION UU f L1O�L 6
VALUATION$ r ¢/SO FT L'SSQ FT
APPLICANT'S SIGNATURE li II'I DATE>
DEPARTMENT DISTRIBUTION q� l CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ' SMIP �LC�
INVOICE f F PAIDAMOUNT -AMOUNT ` +' I CASH OCHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT I I O CASH O CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZED LETTER 0 YES O NO
Clty of Menifee
Building Dept.
MAR 0 5 2018.
Received
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