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PMT18-01031 City of Menifee Permit No.: PMT18-01031 29714 HAUN RD. <ACCELA—. MENIFEE, CA 9258E Type: Residential Plumbing aw'e t., MENIFEE Date Issued: 03/08/2018 PERMIT Site Address: 26936 BUCCANEER DR, MENIFEE,CA Parcel Number: 331-410-045 92585 Construction Cost: $1.900.00 Existing Use: Proposed Use: Description of REPLACE EXISTING 50 GAL GAS WATER HEATER IN GARAGE Work: Owner Contractor TED JONES A R S AMERICAN RESIDENTIAL SERVICES OF 26936 BUCCANEER DRIVE CALIFORNIA INC MENIFEE, CA 92585 965 RIDGE LAKE BLVD#201 Applicant Phone:9012719700 ANDREW ALLEN License Number.765155 A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIi 965 RIDGE LAKE BLVD#201 MEMPHIS, CA 38120 Fee Description get( Amount 1$1 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_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 herebyaffirm under penalty of perjurythat I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and D I am exempt from licensure under the Contractor's State License Law for Professions Code and my license is in full force and effect. the following reason: License ClassmniG qq License No By my signature below I acknowledge that,except for my personal residence 4 Expires Signature in which I must have resided for at least one year prior to completion of improvements covered by this permit.I cannot legally sell a structure that 1 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 a copy of the applicable law,Section have and will maintain a certificate of consent of self-insure for worker's 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 ,,,vva,leeinfo.ca.eov/calaw.h[ml. this permit is issued. Policy# Date have and will maintain worker's compensation insurance,as required by PROPER OWNER OR AUTHORIZED AGENT tection 3700 of the Labor Code,for the performance of the work for which ci my signature below I certify to each of the following;I am the property this permit is issued.My worker's compensation insurance carrier and policy wrier or,authorized to act on the property owners behalf.1 have read this number are application and the information I have provided is correct.I agree to comply Carrier 'r with all applicable city and coun nances and state laws relating to building co strutrowloath representatives of this city or county to Polity# (� Expires enter th dentifi erty for inspection purposes. (This section need not to be completed is the permit is f r one-hundred ^ I(, dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT Date /r,"ertify that in the performance of the work for which this permit is issued, I shall not employ any persp in any ma nmersW to become subject to the CITY BUSINESS LICENSE# workers compensation s ofC I' nia,a ree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the wor s com,Pe�ion ' ions of5ection 3700 ofth Labor Code,lshall fo ith (npi with rov ions. / will the applicant or future building occupant handle hazardous material or Applicant Date S �f mixture containing a hazardous material equal to or greater that the amounts spepifted on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS oYes ffNo UNLAWFUL,AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the 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)1 See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguide/linQS CONSTRUCTION LENDING AGENCY OYes -9No 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 Code) 0 Yes 11""No OWNER BUILDER DECLARATIONS I have read the Hazardou aterial Information Guide and the SCAQMD 1 hereby affirm under penalty of perjury that 1 am exempt from the permitting checklist. riders�-rimy require underthe State of Contractors License Law for the reasons)indicated below by the California Heal 5af 6 e,Section and 25534 concerning hazardous erica rting. checkmark(s)I have placed next to the applicable items)(Section 7031.5 �es o e/ Business and Professions Code).Any city or county that requires a permit to Date � �" L 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 IRRPI 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 licensure 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 D I,as owner of the property,or my employee with wages as their sale 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.eva.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 DAn 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. O No EPA Lead Safe Certified Firm is required for this project because: ci 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 `'MY l4 V enifee DATE 3 113 PERMIT/PLAN CHECK NUMBER TYPE: ❑COMMERCIAL ,IRESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN SUBTYPE: ❑ADDITION ❑ALTERATION []DEMOLITION [:]ELECTRICAL ❑MECHANICAL ❑NEW E'PLUMBING ORE-ROOF-NUMBEROFSQUARES DESCRIPTION OF WORK L, q �1ov� vL C✓Gt G PROJECTADDRESS {f 0 VotiAo1. �f S Y ASSESSOR'S PARCEL NUMBER QL405 LOT TRACT 6 Of Menifee OWNER NAME o riQ S ADDRESS -.(OG1 U vt2 e✓ �✓ k� o, �, CM S PHONE EMAIL fieceiv&ju APPLICANT NAME A YJ rc&� 0 1e, , ADDRESS •r P-t Qe-.-5 t d t Cl'k 92ST"j PHONE G1 rl 3�-A I Q--s-L % EMAIL CONTRACTOR'S NAME R-S OWNER BUILDER? ❑YES 0 BUSINESS NAME ADDRESS Is-:'— w L L et-. (2-t PHONE -f5' 3L4 I q'3-7/ EMAIL CONTRACTOR'S STATE LIC NUMBER -7L,�;75"�57- SSIFICATION C -3 VALUATION$ I g 0 D L SQ FT APPLICANT'S SIGNATURE DATE CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIPINVOICE 1 x AMOUNT 1 J ''� PAID AMOUNT 1G• ,C� J ...+ OCASH t�., CHECK# JCREDR CARD VISA/MC PLAN CHECK FEES PAID AMOUNT JCASH OCHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER Q YES <J NO City of Menifee Building&Sofety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofrnenifee.us Inspection Request Line 951-246-6213 m d i d S A 3 ° µm^ cd N a N m -^. � j^ o D D. Z a T A❑ -� Lr �L o c �o o aJq ° .Z1 D uNi :0 N d Z -n m ,d. 4 M ,dp N o iu n o. N n Z 2 t¢o D :0 m m °S £ 1� b m 0 n'i z r D v ar ..mO � = c = � m C m3w' � NZ O = O = o ° m 99 4 0) nm' =i D D g EL1 v S a Q d m m a W Z o m 0 Z a J 3 ». 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