PMT18-01611 City of Menifee Permit No.: PMT18-01611
29714 HAUN RD. Type: Residential Plumbing
<A—CCEL/-> MENIFEE, CA 92586
MENIFEE Date Issued: 04/06/2018
PERMIT
Site Address: 27721 JEFFERSON AVE,MENIFEE, CA Parcel Number: 329-202-010
92585 Construction Cost: $1.850.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE 40 GALLON GAS WATER HEATER IN GARAGE
Work:
Owner Contractor
JAMES OVERTON A R S AMERICAN RESIDENTIAL SERVICES OF
27721 JEFFERSON AVE CALIFORNIA INC
MENIFEE,CA 92585 965 RIDGE LAKE BLVD#201
Applicant Phone:9012719700
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNU License Number.765155
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
Phone:9012719700
Fee Description ,Qlv Amount f51
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_Pennit_Template.rpt Page 1 of 1
CITY M 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 contractor(s)pursuant to the ContractasState License Law).
Chapter-9(commencing with section 700D)of Division 3 of the Business and ❑1 am exempt from licensure under the ContractorsSute License Law for
Professions Code and myltoeme Is in full force and effect. the following reason:
License CI s� .l License No /
qq Bymysignature below I acknowledge that exceptforosypersonal residence
Expires 91 Signature in which l must have resided for at least one year prlorlo completion of
Improvements covered by this permit.I cannot legallysdl a structure that
WORKER'S COMPENSATION DECLARATION
have built as an owner-builder if it has not been comtrvcled 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 wehsite:
by Section 3700 oftha Labor Code,for the performance of work for which www.leeinfo.ca.eov/calaw.latml.
this permit is Issued.
Policy 11 Date
-�Lhave and wall maintain workers compensation insurance,as required by ZPROPEOWNER OR AUTHORIZED AGENT
Section 3700 of the Labor Code,for the performance of the work for which gnature below l certify to each of the following:I am the property
this permit Ls Issued.My workers compensation insurance carrier and policy uthorized 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
with all applicable city and coup nances and state laws relating to
Carrier buildingc stm Iauth representativesof thlsdtyorcountyto
Policyff ^ 4 Expires enter th dentili erty for inspection purposes.
(This section need not to be completed is the permit is flirune-hundred
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
,car"'ertify that in the performance of the work for which this permit is issued,
Ishallnotemolov any perso many manner so to become subject to the CITY BUSINESS LICENSE
workers compensation s of C Ilia,a gree that if I should become HAZARDOUS MATERIAL DECLARATION
subjectto the work scomy f ion ronsofSection 3700ofth Labor
Code,Ishall Fo ith rfi •wit o ravJ ions. Willthe applicant or future building occupant handle haurdous material ora
Applicant [ Date (T mixture containing a hazardous material equal to orgreater that the
amounts spe 'Red on the Hazardous Materials Information Guide?
WARNING:FAILURETOSECURE WORKER'S COMPENSATIO COVERAGE IS oyes No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Willtheintended use of the building by the applicant arluture building
AND CIVIL FINES UP TO ONE HUNDREDTHOUSAND DOLLARS($30D,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 forguldelin$$s
CONSTRUCHON LENDING AGENCY oyes ->fNo
I hereby affirm that under the penalty ofperjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agencyfor the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) Dyes KIE"No
OWNER BUILDER DECLARATIONS I have read the Hazardou aterial information Guideandthe SCAQMD
I herebyaffrrm under penalty of perjury that l am exempt from the permitting checklist. nder/n�my require underthe State of
Contractors License Law for the reason(s)indlated below by the California Healt Self
�e,Section and 25534concerning
hazardous erica Ring.
checkmark(s)I have placed next to the applicable items)(Section 7032.5 �,as o r
Business and Professions Code).Any city or county that requires a permit to Date 5
construct,after,improve,demolish or repair any structure,prior to its ROPERTY OWNER OR It
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(RRPI
License Law(Chapter 9(commencing with 5ectlon 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 llcensure receiving compensation for most work that disturbs palatin 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 themselvesorthrough their
01,as owner of the property,or my employee with wages as theirsole employees.For more Information about EPA's Renovattan 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 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. D No EPA Lead-Safe Certified Farm B required for this prgnt bemuse:
01,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 Ifyour project does not comply with EPA RRP rule pleasefil out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
� Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: []COMMERCIAL ❑RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: []ADDITION ❑ALTERATION []DEMOLITION ❑ELECTRICAL []MECHANICAL
[—]NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 9,1EPLAtP, Y O OA C C1711f OAS W (L 'HEAT&r-
0 (-IA9-R(2c
PROJECTADDRESS -1-a , [�
ASSESSOR'S PARCEL PARCEL NUMBER 0 �- I'2X? O LOT TRACT
OWNER NAME -)A;wt,S ` TCl"J
ADDRESS I.ti�L.h. o CA c;
PHONE �1�I ' S`�`t ' '.75 79 EMAIL
APPLICANT NAME
ADDRESS cD-c7 L = C 3-C7
PHONE q 5� 31--1 f `+,3-7f EMAIL
CONTRACTOR'S NAME �ZGSGti'G j2ovr�rZ. OWNER BUILDER? ❑YES WNO
BUSINESS NAME
ADDRESS `12SZ7
PHONE 1 EMA 1j. '
CONTRACTOR'S STATE LIC NUMBER (,� LICENSE CLASSIFICATION C.3LG
VALUATION $ FT L SQ FT
APPLICANT'S SIGNATURE DATE `I Z& 4
■
DEPARTMENT DISTRIBUTION A I CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLA ING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT I -CASH OCHECK# 0CREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
i or IvIeriffee
ul Ing Dept.
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
WWW.citI/OfinenifeauS Inspection Request Line 951-246-6213 APR 0 6 2018
Received
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