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PMT18-01386 City of Menifee Permit No.: PMT18-01386 29714 HAUN RD. Type: Residential Plumbing �lICCELA? MENIFEE, CA 92586 MENIFEE Date Issued: 0 312 712 01 8 PERMIT Site Address: 28146 PANORAMA HILLS DR, MENIFEE, Parcel Number: 340-380-037 CA 92584 Construction Cost: $1,500.00 Existing Use: Proposed Use: Description of REPLACE EXISTING 50 GAL GAS WATER HEATER IN GARAGE Work: Owner Contractor FREDERIC PETLER A R S AMERICAN RESIDENTIAL SERVICES OF 28146 PANORAMA HILLS DRIVE CALIFORNIA INC MENIFEE,CA 92584 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 ,t3ty. Amount fb1 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 far the projects hereby,affrrm under penalty of perjury that 1 am under provisions of with a licensed contractors)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 Code and my license Is in full force and effect. the following reason: License Cl qqs .)6 License No By my signature below l acknowledge that,except formypersonal residence Exp! Signature inwhich l must have resided for at least one year priorto completion of WORKER'S COMPENSATION DECLARATION improvements covered by this permit I cannot legally sell a structure that I 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 www.Ieginfo.ca.gxov/caiaw.htmL permit is Issued. Policy# Date '>Lhave 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 /o�Smysignature below lcertify to each of the following:lam the property this permit is issued.My workers compensation insurance carrier and policy w6 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 building all applicable city and coun nances and state laws relating to building co stru Iauth representatives of this city or county to Policy# ^ (SiJ Expires enter th dentifi erty for inspection purposes. (This section need not to be completed is the permit is f rone-hundred Date �� dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT ertify that in the performance of the work for which this permit is issued, I shall not emolov any perso in any mannersop to become subject to the CITY BUSINESS LICENSE# workers compensation alas of C 1- nia,a ree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the wor sco�'..tio ' ions ofSection370Dofth Labor Code,Ishall fo ith z� rov' ions. Will the applicant or future building occupant handle hazardous material ora Applicant Date �.{ mixture containing a hazardous material equal to or greater that the amountsspe fred on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATIOP OVER Is o Yes No UNLAWFUL,AND SHALL SUBJECT AN 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 requires permit for the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCtionor See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air CONSTRUCTION LENDING AGENCY aYes �o I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility he 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) o Yes ltrho OWNER BUILDER DECLARATIONS I have read the Hazardou aterial Information Guide and the SCAOMD I hereby affirm under penalty of perjury that lam exempt from the Permitting checklist. nder a my require underthe State of Contractors License Law for the reason(s)indicated below by the California:Healar Saf de,Section and 25534 concerning checkmark(s)I have placed next to the applicable items)(Section 7031.5 h/azardou ica rting.Business and Professions Code).Any city or county that requires a permit tores construct,alter,improve,demolish or repair any structure,prior to its Date Issue nce,also requires the applicant for the permit to file a signed statement ROPERtt OWNER ORAUTHORIZEDAGENT that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION.REPAIR AND PAINTING IRRPJ 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 ol,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 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 oAn 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: 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 rill out the RRP Acknowledgement BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION 4� Menifee DATE 3) PERMIT/PLAN CHECK NUMBERl�'Q�'3 TYPE: ❑COMMERCIAL RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA [-]SIGN SUBTYPE: []ADDITION []ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAI. of Menif e [:]NEW ❑/ PLUMBING ❑RE-ROOF-NUMBEROFSQUARES City Building E)Gp:. DESCRIPTION OF WORK tp A c 'j 0 Gti/At CAA ( I N 42p&E MA R a PROJECTADDRESS aSHU PA r,.l ,.Dp� IL ,S Pa 1�t;)5SAReceived ASSESSOR'S PARCEL NUMBER LOT TRACT OWNER NAME I LE(- ADDRESS a81L4(.o PANOCArAA H 14L M (Fri A Cd PHONE q51 a3--1 `7090 EMAIL APPLICANT NAME ADDRESS v--/ A o vzfz 2SL 1 PHONE Vic-( ( 0(3) I EMAIL CONTRACTOR'S NAME }2f, OWNER BUILDER? ❑YES NO BUSINESS NAME ADDRESS 1,S90' L-/ L I NOEN ST t ,4F c '5(C)C CA " O Sb'7 PHONE 73.? 1 EMAIL CONTRACTOR'S STATE LIC NUMBER —7(oSI S� LICENSE CLASSIFICATION LCD�p VALUATION $ ('I�tX' L SO,FT APPLICANT'S SIGNATURE DATE L �/ ClrY STAFF USE A DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN ' — SMIP X INVOICE ` PAID AMOUNT AMOUNT 11 0 CASH 0CHECK# OCREOITCARD VISA/MC PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER 0 YES O NO City of Menifee Building& Safety Department 29714 Haun Rd. 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