PMT18-02071 City of Menifee Permit No.: PMT18-02071
29714 HAUN RD. Type: Residential Plumbing
�J-�CCELA> MENIFEE, CA92586
MENIFEE Date Issued: 04/30/2018
PERMIT
Site Address: 28175 WINDSAIL CT, MENIFEE,CA Parcel Number: 364-043-019
92584 Construction Cost: $1,700.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE 50G GAS WATER HEATER IN GARAGE
Work:
Owner Contractor
FRANCISA LEE A R S AMERICAN RESIDENTIAL SERVICES OF
28175 WINDSAIL COURT CALIFORNIA INC
MENIFEE, CA 92584 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
Fee Description Qtv Amount(S)
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_Permil_Template.rpt Page 1 of 1
h*jwu Oeqv AV,s
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I herebyaffirm under penalty of perjury that l am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter!)(commencing with section 7000)of Division 3 of the Business and o I am exempt from Iicensure under the Contractor's State License Law for
Professions Code and my license Is In full force and effect the following reason:
License Cl qqY License No By my signature below l acknowledge that,exceptformypersonal residence
Expires NI Signature inwhich l must have resided for at least one year prtortocompletion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.)cannot legallysella 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 workers 7044 of the Business and Professions Code,is avallable upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted Drat the following websiie:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.leeinfo.ca,eav{calaw.htmi.
Policy N Date
thave and will maintain worker's compensation insurance,as required by 7PROPEROWNER OR AUTHORIZED AGENT
ctton 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 is issued.My worker's compensation insurance ureter and policy uthorized to act an the property owners behalf.I have read this
number are application and the information l have provided is correct l agree to comply
Carrier 'r with all applicable city and coun nances and state laws relating to
building co stru loath representatives of thb City or county to
Polity# •^ (�i t Expires enter th dentin erty for inspection purposes.
(This section need not to be completed is the permit Is f r one-hundred ,
dollars($100)or less Date
PROPERTY OWNER OR AUTHORIZED AGENT
certify that in the performance of the work for which this permit is issued,
I shall not employ any perso inanymannerso to become subject to the CITY BUSINESS LICENSE#
workers compensation soIC Itf�ia,a gree that iflshould become HAZARDOUS MATERIAL DECLARATION
subject to the wor cam,�PP�!on ions of Section 370D of Labor
Code,l shall to ith 6/i/pI wit rout ions. Will the applicant or future building occupant handlebazardaus material ora
Applicant Date (� mixture containing a hazardous material equal to or greater that the
amounts spe fled on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS aYes 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 requires 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 OFTHE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelin$$s
CONSTRUCTION LENDING AGENCY crYes 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 pernrlt Is Issued outer boundary of a school?
(Section 3097 Civil Code) D Yes IAO
/
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. ndermy require underthe State of
California Healt Saf de,Section and 2553q concerning
Contractors License Law for the reason(s)indicated below by the hazardous aria ding.
checkmark(s)I have placed next to the applicable items)(Section 7032.5 �oies o Business and Professions Code).Any city or county that requires a permit to Date
construct,after,Improve,demolish or repair any structure,prior to its HOPERTYOWNER OR AUTHORIZED AGENT
Issuance,also requires the applicant for the permit to filea signed statement
that he or she is licensed pursuant to the provisions of the Contractors 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 painting pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence compenor sationre frmostcility to eRRPthatditurbs ainina pry
with
than
Applicant for a permit subjects the applicant too civil penalty of not more required practices.This Includes rental property owners and property
than($S00). managers who do the paint-disturbing work themselves or through their
or',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.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,13usiness and Professions 1.800-424-LEAD(5323).
Code,The Contractor's 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. ❑No EPA Lead-Safe Certified Firm Is required for this project because:
0 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 AN out the RRP
Acknowledgement.
• IT/PLAN • •
,V�4
Menifee
DATE PERMIT/PLAN CHECK NUMBER 0 I —0201
TYPE: []COMMERCIAL ORESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL [-]MECHANICAL
❑NEW QPLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK (Zr—Pc. CC "lei (7�-1C • W G;
�T
PROJECT ADDRESS YJ
ASSESSOR'S PARCEL NUMBER �u'' b�� l�`G LOT TRACT
OWNER NAME I-fI-P'm G 0 ELF
ADDRESS N p '' IL c� Gw IFre"
PHONE 771 y - ((i (2, ' (y(;, 16 EMAIL
APPLICANT NAME AI,I,() E " A LLB-r--
ADDRESS tt S Do b(N17�)'} i�Cr
PHONE `O((( EMAIL
CONTRACTOR'S NAME as 6(-�c Q OWNER BUILDER? ❑YESZW
BUSINESS NAME ADDRESS IS II�l••11
fV W C1NDahl ST IV/,7e-5I(x' CP} q,?-VV7
PHONE q'Sf '3ti► 97"7i EMAIL
CONTRACTOR'S STATE L ,ICNUMBER �� ^ SE CLASSIFICATION C �L
VALUATION$ ,-rLI V J L SO,FT
APPLICANT'S SIGNATURE DATE `I 1 3 C)
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAIDAMOUNT
AMOUNT I I OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED ()YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
ru of 8
Mldin9 e
City of Menifee Building&Safety Department 29714 Haun Rd, Menifee, CA 92 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213 APR 3 ZD�B
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