PMT18-02347 City of Menifee Permit No.: PMT18-02347
29714 HAUN RD. Type: Residential Plumbing
�f- CCEL/? MENIFEE, CA 92586
MENIFEE Date Issued: 0 511 412 01 8
PERMIT
Site Address: 26767 ALTA AVE, MENIFEE,CA 92585 Parcel Number: 331A62-022
Construction Cost: $1,850.00
Existing Use: Proposed Use:
Description of REPLACE 50 GALLON GAS WATER HEATER IN SAME LOCATION (GARAGE)
Work:
Owner Contractor
KEITH MOMON A R S AMERICAN RESIDENTIAL SERVICES OF
26767 ALTA AVE 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 CALIFORNb
965 RIDGE LAKE BLVD#201
MEMPHIS,CA 38120
Fee Description Qtv Amount I$1
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 building 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_Permit_Template.rpt Page 1 of 1
Ai Aft#)- Av,s
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I herebyaffsrm 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 ❑I am exempt from licensure under the Contractors5tate License Law for
Professions Code and my license is in full force and effect. the following reason:
License Ci — S License No By my signature below l acknowledge that,except formypersonal residence
Expires 9�Qf,1f Signature in which l must have resided for at least one year priortocompletion 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 certificate 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 following website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.leeinfo.ca.eov/calaw.litmi.
Policy 0 Date
,7SrOave 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 off my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy w>( of 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 coup Inances and state laws relating to
bWcostru �Iauthepresentatives of this city or county to
Policy g ^ (� A Expires ey for inspection purposes.^
(This section need not to be completed is the permit is f role-hundred
dollars($100)or less Date
PROPERTY OWNER OR AUTHORIZED AGENT
,a'rcertity 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 g
workers compensation s of lif hia,a gree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the wor scorrip Ion 'tons of Section 3700 ofth Labor
Code,I shall f/orb ith sfsp).wit o rovJ tons. Will the applicant or future building occupant handle hazardous material or
Applicant/ G Date C.f mixture containing a hazardous material equal to or greater that the
�Y amounts spe 'fled an the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATIO COVERAGEIS ❑Yes 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 require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management heconDistrict(SCtionor See permitting from
checklist
IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air
jua
CONSTRUCTION LENDING AGENCY Dyes; =
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) o Yes�o
OWNER BUILDER DECLARATIONS I have read the Hazardou aterial Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that l am exempt from the permitting checklist. nde /an't!'my require under the State of
Contractors License Law for the reason(s)indicated below by the California Healt Safe de,Section and 25534 concerning
checkmark(s)I have placed next to the applicable ftem(s)(Section 7031.5 hazardous eria rting.
Business and Professions Code).Any city or county that requires a permit to Ypres o n/ I
construct,alter,improve,demolish or repair any structure,prior to its Date G5 l
issuance,also requires the applicant for the permitto file a signed statement ROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING fRRPI
License Law(Chapter9(commencing with Section 700D)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 painting pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence compensor ationre for
mosty to eork that disturbs
s pain ina pre-19ply th
than
Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property ownersand 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 Renovation Program visit:
compensation,will do( )all of or( I 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 Firm is required for this project because:
D 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 If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Wenifee
DATE - I,' PERMIT/PLAN CHECK NUMBER — T�
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION []DEMOLITION ❑ELECTRICAL [—]MECHANICAL
❑NEW ❑✓ PLUMBING El RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Replace 50 gallon gas water heater in same location(garage).
PROJECTADDRESS 26767AItaAve
ASSESSOR'S PARCEL NUMBER 114 G7�Z2. LOT (OT7 TRACT
OWNER NAME Keith Momon
ADDRESS 26767 Alta Ave.Romoland,CA 92585
PHONE (858)663-1367 EMAIL
APPLICANTNAME m /e
ADDRESS 1520 W Linden Street Riverside, CA 92507
PHONE (951)341-9371 EMAIL
CONTRACTOR'S NAME ARS Rescue Rooter OWNER BUILDER? ❑YES❑✓NO
BUSINESS NAME
ADDRESS 1520 W Linden Street Riverside, CA 92507
PHONE (951)341-9371 EMAIL
CONTRACTOR'S STATE LIC NUMBER 765155 LICENSE CLASSIFICATION C36
VALUATION$ L SQ FT
APPLICANT'S SIGNATURE DATE -�- / /'�f I( 3
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 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 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-5213
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