PMT18-02072 City of Menifee Permit No.: PMT18-02072
29714 HAUN RD. Type: Residential Plumbing
�CCELj MENIFEE, CA 92586
MENIFEE Date Issued: 0413012018
PERMIT
Site Address: 26143 SHADYWOOD ST, MENIFEE, CA Parcel Number: 335-422-026
92586 Construction Cost: $1,797.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE 40G GAS WATER HEATER IN GARAGE
Work:
Owner Contractor
RUTH ESTERELLADO A R S AMERICAN RESIDENTIAL SERVICES OF
26143 SHADYWOOD ST CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD#201
Applicant Phone:9012719700
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNb License Number:765155
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
Fee Description gtv Amount Isl
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_BIdg_Permit_Template.rpt Page 1 of 1
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CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contacts for the projects
1 herebyaffurn under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing With section 7000)of Division 3 of the Business and o 1 am exempt from licensure under the ContractortSiate License Law for
Professions Code and my license is in full force and effect. the following reason:
License Cl qq ,Js License No i� � By my signature below l acknowledge that,except formypersonal residence
Expires 4f Signature In which l must have resided forat leastoneyear prior tocompletion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legallysell 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 certirimte of consent of self-insure for workers 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 fallowing webslie:
by Section 3700 of the Labor Code,for the performance of work for which
this permit Is Issued. www.leginfo.ca.gov/calaw.html.
Policy R Date
',7Lhave and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
Section 370D of the Labor Code,for the performance of the work for which oy_Y/my signature below l certify to each of the follmving:I am the property
this permit is issued.My workers compensation insurance carrier and polity w>✓," net Or authorized to act on the property owners behalf.I have read this
number are 1 application and the information I have provided is correct.I agree to comply
Carrier It7. '1� with all applicable city and caunVnanc-and state laws relating to
huiidIngc stru .lauth representatives of this city or county to
Poliryg +' (�DI� _Expires enter th entifi erty far inspection purposes.r�
(This section need not to be completed is the permit is f r one-hundred
dollars($100)or less Date 77
PROPERTY OWNER OR AUTHORIZED AGENT
�ertify that in the performance of the work for which this permit is issued,
-I shall not employ any perso In any manner so to become subject to the CITY BUSINESS LICENSE It
workerscompensation sof Ipma,a tee that if should become HAZARDOUS MATERIAL DECLARATION
subject to the in comy�ion -ions of Section 3700 of the,Lahor
Code,)shall fo nth Fi it rovj ions. Will the applicant orfuture building occupant handle hazardous material ora
Applicant L Date �.( mixture containing a hazardous material equal to orgreater thatthe
amounts spa pried on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATIO COVERAGE IS OYes 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 D OLLARS($100,000),IN occupant require permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant Quality Management hecoDistrict(9Ctionor See permitting checklist
IN SECTION 3706 OF THE LIBOR CODE,INTEREST,AND ATTORNEYS FEES fo astAirlrres
Qua
CONSTRUCTION LENDING AGENCY aYes -r: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) ❑Yes I-CANo
OWNER BUILDER DECLARATIONS I have read the Hazardou ateriai Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the
permitting checklist. nde Amy require underthe State of
Contractors License Law for the reason(s)indicated below by the California Healt Saf He,Section and 25534 concerning
checkmark(s)I have placed next to the applicable ftem(s)(Section 7031.5 hazardous en. rting.
x
Business and Professions Code).Any citypr county That requires permit to (es o Oate LS
construct,alter,improve,demolish or repair any structure,prior to its ROPERTYOWNER OR AUTHORIZED AGENF
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 IRRPI
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 licensure in receiving compensation for most work that disturbs painti re-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by p
residence or childcare facility to be RRP-certified firms and comply with
than
Applicant fora permit subjects the applicant too civil penaltyof not more required practices.This includes rental property owneoand property
than($500). managers who do the paint-disturbing work themselves or through their
o1,as owner of the properly,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 aAn EPA Lead-Safe Certified Renovator will he 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 Firm is required for this project because:
o 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 Urense 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
Lt
Menifee
DATE PERMIT/PLAN CHECK NUMBER 1 — L/ !-/-1
TYPE: ❑COMMERCIAL RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑NEW OPLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK // / ; A ' CIJ 1�1 • , A& ,
PROJECTADDRESS 0, 0 415 51rU,140yciono -or- v I ;,F �s -i'
ASSESSOR'S PARCEL NUMBER I -b2-WOT TRACT
OWNER NAME A 0—1 H S• --M-4FL[,01,00
ADDRESS ICI 2
2 SH1WyeJC900 51r >>� Gt� (f6
PHONE 45— 313 tla9& EMAIL
APPLICANT NAME X.)-o 1[^w Ai—(,c-N
ADDRESS pZV^
PHONE �t S-( '�:)L J A G{37( EMAIL
CONTRACTOR'S NAME 2 OWNER BUILDER? ❑YES NO
BUSINESS NAME
ADDRESSJ.S,20CI) S f
PHONE 9,S ( '2>-f -7 ( EMAIL
CONTRACTOR'S STATE LIC NUMBER -7( A�CENSE CLASSIFICATION 3Cp
VALUATION$ -7CJ -I L SO FT + i
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT - CASH -CHECK# i}CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH 0CHECK# -CREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES - NO DL NUMBER NOTARIZED LETTER - YES O NO
City0
Building 08FE.
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213 APR 3 0 2018
Received
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