PMT18-01032 City of Menifee Permit No.: PMT18-01032
29714 HAUN RD. Type: Residential Plumbing
CA6CE!0�? MENIFEE, CA 92586
(iprnxq B.+lMxC MENIFEE Date Issued: 0 310 812 01 8
PERMIT
Site Address: 27665 AVENIDA INTERNO, MENIFEE, CA Parcel Number: 333-271-022
92585 Construction Cost: $1,800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 50 GAL GAS WATER HEATER IN GARAGE
Work:
Owner Contractor
LEVI KELLY A R S AMERICAN RESIDENTIAL SERVICES OF
27665 AVENIDA INTERNO 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 CALIFORNI/
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
Fee Description gty Amount ISI
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 staled,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_Permk_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 perjurythat I am under provisions of with a licensed comractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License Law for
Professions Cade and my license Is in full force and effect. the following reason:
License CI s License No By my signature below 1 acknowledge that,except for my personal residence
QQff
Expires 9l Signature in which l must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
o l 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 www.Ieginfa.ca.Roy1calaw.html.permit is issued.
Policy# Date
,7Su�have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which 13 my
signature below I certify to each of the follpwing:l am the property
this permit is issued.My worker's compensation insurance carrier and policy cob ner Or authorized to act on the property owner's behalf.I have read this
number are application and the information I have provided is correct.i agree to comply
Carrier � with all applicable city and court nances and state laws relating to
��gg building co stru lauth representatives of this city or county to
Policy# 9 (Sb l Expires enter th dentifi erty for inspection purposes. I/
(This section need not to be completed is the permit is f r one-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 In any mannerso to become subject to the CITY BUSINESS LICENSE#
worker's compensation s of C I' nra,a gree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the war s coannP�ion 'ions of Section 3700 ofth Labor
Code,Ishall To ith Grill •wit o soy'ions. Will the applicant or future building occupant handle hazardous material or
Applicant Date �f mixture containing a hazardous material equal to or greater that the
amounts spe tied on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATIO COVERAGE IS oYes No
UNLAWFUL,AND SHALL SUBIECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or 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 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY oyes -�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 Code) n Yes (.11-No
OWNER BUILDER DECLARATIONS I have read the Hazardou aterial Information Guide and the SCAQMD
permitting checklist. ndersa my require under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Healt 5af de,Section and 25534 concerning
Contractor's License law for the reason(s)indicated below by the hazardous eria rting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 A lk
e e/
Businessand Professions Code).Any city or county that requires a permitto 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 Contractor's 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 Iicensure 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
o 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 for sa le.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of aAn 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:
D 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 a utthe RRP
Acknowledgement.
PERMIT/PLANBUILDING & SAFETY A. • •
415
Menifee
DATE PERMIT/PLAN CHECK NUMBER Piws
TYPE: El COMMERCIAL RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: []ADDITION []ALTERATION []DEMOLITION []ELECTRICAL El MECHANICAL
[]NEW EIPLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Czc-2 c�� lo✓� 43 t..5afi-n.r �P ;-e"-
✓t CL Y-n e
PROJECFADDRESS 97CaCp S vai I o�A rn
ASSESSOR'S PARCEL NUMBER o'r l -�� LOT TRACT City of Menifee
OWNER NAME Lev l< e l+ UI t.
building Dept
ADDRESS a7&(pS I R omnhvjA 9DD y6YAR 0 8 2018
PHONE 94 i, aLlLv• 1L-I-7 X EMAIL
APPLICANT NAME j,W l
ADDRESS G vlaleyl v �e ?5-07
PHONE q57 -31-/(- 157f EMAIL
CONTRACTOR'S NAME S afScmg OWNER BUILDER? ❑YES NO
BUSINESS NAME ADDRESS ` Ver5lje 64 4, v,.,y�
7
PHONE Q,$/ - 3c./! - 9-3 7/ EMAIL
CONTRACTOR'S STATE LIC NUMBER NSE CLASSIFICATION
VALUATION$ 500 L SQ FT
APPLICANT'S SIGNATURE DATE J S I
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP X
INVOICE PAID AMOUNT ��5.15
AMOUNT ' �� O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUPti OCASH OCHECK It 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 Haan Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request line 951-246-6213
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