PMT18-01633 City of Menifee Permit No.: PMT18-01633
29714 HAUN RD. Type: Residential Plumbing
e�CC ;301. MENIFEE,CA 92586
MENIFEE Date Issued: 04/10/2018
PERMIT
Site Address: 29198 WILLOWS LANDING DR, Parcel Number: 333-333-023
MENIFEE,CA 92585 Construction Cost: $1,100.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 50 GAL WATER HEATER IN GARAGE
Work:
Owner Contractor
VITO DEGUZMAN A R S AMERICAN RESIDENTIAL SERVICES OF
29198 WILLOWS LANDING 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 9.t.Y Amount
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 carded 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
Ailaw, w Aw- Ass
CITY OF 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 Contactors 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 CI -JLY License No J By my signature below I acknowledge that,except formy personal residence
Expires J R qq Signature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit 1 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
this permit Is issued. www.leginfa.m.eov/calaw.html.
Policy# Date
`�Lbave and will maintain workers 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 my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and polity wner or authorized to act on the property owners behalf.I have read this
numberare application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and coun nances and state laws relating to
building co stru .Iauth representatives of this city or county to
Policy If ^ (0 if,I t Expires enter th dentifi erty for inspection purposes.
(This section need not to be completed is the permit is f r one-hundred ry
dollars($100)or less Date
� PROPERTY OWNER OR AUTHORIZED AGENT
ertitythat in the performance of the work for this permit isissued,
I shall not emolov any pe nnersw to become subject to the CITY BUSINESS LICENSE#
workers compensation s of CC R nia,a ree that if I should become HAZARDOUS MATERIAL DECLARATION
subjecttothe work com cr Ion .tons of Section 3700 ofth Labor
Code,I shall finIth pl .wit o rov ions. Will the applicant or future building occupant handle hazardous material or
Applicant O Date (,( mixture containing a hazardous material equal to or greater that the
amounts spe 'fled an the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATIOd COVERAGE IS a Yes gfNo
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 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(SCAQMDr7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo Coast
Airllnes
Qua
CONSTRUCTION LENDING AGENCY oYes -tr�No
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 school?
(Section 3097 Civil Code) a Yes llif—No
OWNER BUILDER DECLARATIONS I have read the Hazardou aterial Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist. nde a my require under the State of
Contractors License Law for the reason(s)indicated below by the California Healt Saf de,SectiogV, and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous eda rting.
Business and professions Cade).Any city or county that requires a permit to 15es o
construct,alter,improve,demolish or repair any structure,prior to its Date L 5
issuance,also requires the applicant for the permit to file a signed statement eisROPERTY OWNER ORAUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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 receiving or compensation
facilityto6eork that distuified firmsandnamplywfth
an Applicant for a permit subjects the applicant to a civil penalty of not more required acteces.7his includes rental property than($50D). q P p p rty owners and property
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.eaa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-803-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a An 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 bemuse:
o I,as owner of the property am exclusively contacting with licensed
contactors 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 CHECK APPLICATION
_
i J
Menifee
DATE t'( 10 f PERMIT/PLAN CHECK NUMBER e)' 3
TYPE: [—]COMMERCIAL RESIDENTIAL [—]MULTI-FAMILY ❑MOBILEHOME POOL/SPA ❑SIGN
SUBTYPE: [:]ADDITION []ALTERATION [—]DEMOLITION [—]ELECTRICAL ❑MECHANICACity Of Men fee
❑NEW PLUMBING ❑RE-ROOF-NUMBEROFSOUARES Building D pt.
DESCRIPTION OF WORK +tie- S E'� • bJ t/L 8✓L `J�rani[
J "1118
PROJECTADDRESS WI L_ `� L Ar9 ioiN Z iD,2 . ed
ASSESSOR'S PARCEL NUMBER �Z LOT TRACT
OWNER NAME ;�L)Z.M1ti 14t-1
ADDRESS I L i s0( J(-�
PHONE q sl -7, 3 aa(s EMAIL
APPLICANT NAME Ltd r(,.� IWO
ADDRESS I S-a0 t
PHONE Ul S( 0731L l ( G("b l ( EMAIL
CONTRACTOR'S NAME OWNERBUILDER? DYES ONO
BUSINESS NAME
ADDRESS I SJc�> Lt.) N r '2 L %: soa: C>--k afozmn-7
PHONE C�3( 2)Lj L
CONTRACTOR'S STATE LIC NUMBER -7 SO _ LICENSE CLASSIFICATION L34%
VALUATION$ L U L SO FT
APPLICANT'S SIGNATURE DATE
Grd
DEPARTMENT DISTRIBUTION t, CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN $MIP k
INVOICE PAIDAMOUNT
AMOUNT 1 � 15. OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# 0CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us laspection Request Line 951-246-6213
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