PMT18-02341 City of Menifee Permit No.: PMT18-02341
MENIFEE,
EE, C 92 Type: Residential Plumbing
D.
ACCEL./� MENIFEE, CA 92556
MENIFEE Date Issued: 05/11/2018
PERMIT
Site Address: 27387 PROMINENCE RD, MENIFEE, CA Parcel Number: 335-453-010
92586 Construction Cost: $2,942.00
Existing Use: Proposed Use:
Description of REPLACE 40 GALLON WATER HEATER IN GARAGE
Work:
Owner Contractor
ANNE DAVY A R S AMERICAN RESIDENTIAL SERVICES OF
CALIFORNIA INC
965 RIDGE LAKE BLVD.#201
Applicant Phone: 9512769744
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNP License Number:765074
965 RIDGE LAKE BLVD.#201
MEMPHIS, CA 38120
Fee Description PIN: Amount ISI
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-remplate.rpt Page 1 of 1
CITY OF MEMFEE
LICENSED DECLARATION pmPerty who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that l am under provisions of with a licensed mntractor(s)Pursuant to the Contractors State License law).
Ch2pter9(commencingvfith section 7000)ofDivisfon 3 of the Business and Ol am exempt from licensum under the Contractor's Slate lkense Law,for
Professions Code and my license is in full forte and elf�efct the following reason:
Ucensetlas GO�C2o/G3(a_tirens_e No. [��7
Bymysignature below l acknowledge that,except for my personal residence
Expires in which l must have resided for at least one year prior to completion of
WORKERS COMPENSATIIOS,N_OECLgRAT1ON improvements covered by this permit l cannot legally sell a structure that I
f,I hereby affirm under penalty of perjury one of the following declarations:) have bull[as an owner-builder if it has not been constructed in its entirety by
have and will maintainacertificato ofconsentofself-Insure forworkers licensed contractors.l understand theta copy of the app➢cable law,Section
compensation,issued by the Director of Industrial Reladom asprovjded far 7044 ofthe Business and Professions Code,is available upon requestwhen
by5ection 3700 ofthe labor Code,for the performance or work forwhich this application is submitted or at the following website:
this permit is issued. _vnnv.Ie gin to,ca.eov/caIaw htrn1.
Policy It
Date
D l have and will mainaln worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 370D of the tabor Code,for the performance of the work forwhich ❑By my signature below l certify to each of the following:I am the property
this permit is issued.My worker's compensation imurance carrier and policy owner or authorized to act an the propertyovmefs behalf.I have read this
numherare: / application and the information l have provided is correR l agree to comply
Carver Lf with all applicable city and county ordinances and state lava relating to
h pop buildingconstruction.I authorize representatives ofthacityorcountyto
Poliryg7�)S/]2/ �l6fU Expf _ V /� enter the above identified property for inspecdon purposes.
(This section need—no tto be completed is the permit as for one-hundre
dollars(Sian)or less Date.
Olcertify PROPERTY OWNER ORAUDIONZED AGENTthatin the performance Of this permit is issued, '7 � '
Ishall not employ any persons in any manner so as to become subject to the CITY BUSINESS UCENSE# Jl: 1
worker's compensation laws of California,and agree that if I should become
subject to the workers comperrsatio0 provisions of Section 3700 of the Labor RDOUS MATERIAL DECLARATION
Code,I shall forthw complywiththoseprovisions. j� ill the aoo0cantor furore bufldfng ottvpant handle hazardous material ora
Applicant Date I"I� I(J �recanmininga hazardous material equal toorgreaterthatthe
�--�— r amountsspedrred on the Hazardous Materials Information Guide?
WARNING FAILURE TOSR16REWORKWSCOMPENSATIONCOVERAGELS ayes
UNIAWFUL,AND SHALLSUB1ECfAN EMPLOYERTO CRONINALPENALMES
AND CIVIL FINES UPTO ONE HUNDREDTHOUSAND DOLLARS($1D0,000),IN Will theintended use of the building bythe appifcantor future building
ADDITION TOTHE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant requirea permit forthe constructionormodiBcation from South
IN SECTION 37060F711El/TBOR CODE,INTEREST,AND ATTORNEYS FE6 /.OdSCAIf quality Management District'SCAOA4D)?See permitting checklist
forguide0nes
CONSTRUCTION EENDINGAGENCY ores /No
I herebyaflfrm that under the penaltyatperjury there is a construction Will the proposed building or modified facility be within 1000feetofthe
lending agency for the performance ofthe work which this permltis issued outer boundary of a school?
(Section 3097 Civil Code) oyes a�
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I herebyaffrnn under penalty of perjury that l am exempt From the permitting checklist l understand my requirements under theState of
Contractors License Law for the reason(s)indicated belovi by the CaliFomia Health&Safety Code,Section 25505 and 25534 concerning
chedmtark(s)I have placed next to the applicable item(s)(Sectfon 70315 hazardous material reporting.
Business and Professions Code).Any city or county that requfrmsa permit to oV ONo _ /_/�''r�
construct,after,Improve,demolish or repair any structure,prior to its Date
Issuance,also requires the applicant forthe Parrott to file a signed statement PROPERTY
OR OR
EO AGEIPr�' `
that he or she IS licensed pursuant to the provisions of the Contractors state EPARENOVATION.REPAIRANDPAINHNG(RRPI
Ucense Law(Chapter9(chmmendng with Section 71100)of Division Si of the
Business and Professions Code)or that he orshe is exemptfrom Rconsure The EPA Renovation Repair and Painting(RRP)Rule requiresmntractnrs
and the basis for the alleged exemption.Any violation ofsertoq 70315 by receivrmgcompensationformostworktha[dfsturbspaintinapre-1978
an Applicant for a permitsubjects the applicant to a civifpenally'oFnot more residenceorchildmm&clitytobe RRP-certifiedfimaandcwpiywith
than($500). ' fequlmd practices.This includes rental propertyowners and property
managerswho do the pafnt-duturbing work themselves or through their
a1,as owner ofthe property,ormy employee with wages astheirsole employees.Formominformatiun about EPA's Renovation Program visit:
compensation,willdoOalloforOportion,of the work,and the structure is vnmveoa.eovgead or contact the National Lead Information Center at
not intended or offered for sala(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License taw does not apply to an owner ofa
property who,through employees'or personal effort builds or Improves the aAn EPA Lead-Safe Certified Renovator will be responsible for this project
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 yearof -
6ompletion,the Owner-Builder win have the burden of proving that It was Firm Certification No
not built orimproved for the purpose of sale. a No EPA Lead-Safe Certified Finn is required for this proJectbecame:
a 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 no[apply trier,owner of a
If your project does not comply with EPA RRP rule please fill out the RAP
Acknowledgement
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: ' I ` I PERMIT/PLAN CHECK NUMBERP l l O 23u )
PLANNING CASE NUMBER
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW LUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK Aj kL 1()A 79JZ 99ArC_e
n 2�'7 � / IM EAJ� tE
PROJECTADDRESS �C 71!8 1,qF cr �j ZIP , .
ASSESSOR'S PARCEL NU"MB�EgR a� OT TRACT'
OWNERNAME AAJIU
ADDRESS >✓ f`fS /0 _- C/ef—
PHONE &2 (n(.Q.D(b75 EMAIL
APPLICANT NAME f f/v y Acel
ADDRESS � 3 " egs •!f:r—
d / G�✓S/[,C. C'/�- 9a ?
PHONE � �p 6,&- �(P 7S EMAIL
CONTRACTOR'S NAME 7-1 OWNER BUILDER? O YES ONO
BUSINESS NAME 7<Gli� GCE �ll�iCes
ADDRESS
PHONE �Gc' Cp/pd O •7j� /EEMAIL
CONTRACTOR'S STATE LIC NUMBER 7G SD 7 -y LICENSE CLASSIFICATION C'/D C Zo C 3 jQ
VALUATION$ SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITYC MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE �^
INVOICETOTAL I �, IL7 GREEN SMIP
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER 0 YES NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofinenifee.us City of Menifee
Building Dept.
NIF
MAY 1 12018 _..
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