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
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