PMT18-02483 City of Menifee Permit No.: PMT18-02483
29714 HAUN RD.
�CCELA? MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 05/21/2018
PERMIT
Site Address: 27155 STAGEWOOD ST,MENIFEE,CA Parcel Number: 335-424-034
92586 Construction Cost: $2,500.00
Existing Use: Proposed Use:
Description of REPLACE 40 GAL GAS WATER HEATER,SAME LOCATION IN GARAGE
Work:
Owner Contractor
AMPARO AGUILAR A R S AMERICAN RESIDENTIAL SERVICES OF
27155 STAGEWOOD ST CALIFORNIA INC
MENIFEE,CA 92586 965 RIDGE LAKE BLVD.#201
Applicant Phone:9512769744
DAVID FERGUSON License Number:765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNb
965 RIDGE LAKE BLVD.#201
MEMPHIS, CA 38120
Fee Description Qtv Amount f$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
$115.16
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_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a Ifcensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑1 am exempt from[!censure under the Contractors State License law for
Professions Code and my license is in full force and effect.. ��-'i� the following reason:
License ClasrUO�G2o/C3l�Licens No. —265CV7 Ty mysignature below l acknowledge that,except for my personal residence
Expires / — (signature_ in which I must have resided for at least one year prior to completion of
/ improvements covered by this permit.I cannot legallysell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
lIt
hereby affirm under penalty of perjury one of th,roilowing declarations:I licensed contractors.I understand that a copy of the applicable law,Section
ave and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and 11mlessions 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 tabor Code,For the performance of work for which vnnv.leeinFo.ca.eov/calaw.html.
this permit is issued. ,
Policy It Date
D 1 have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below l certify to each of the following:l am the property
this permit is issued.My worker's compensation insurance mrrier and policy owner or authorized to act on the property owner's behalf.I have read this
numberare: application and the information I have provided is correct.I agree to comply
Cartier
L� y�J (' with all applicable city and county ordinances and state laws relating to
`' {�. building construction.I authorize representatives of this city or county to
Policy# 7L-" Dr0K'I2'1 i,j7 Xps. 1i71i; j- enter the above identified property for inspection purposes.
(This section need not to be completed is the permit rs for one-huun red Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued, d 3 J t I�'7 y
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE • I
worker's compensation laws of California,and agree that IF Should become ZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall fcrthwbh c I r,1,6^se orovisions. r� / !( Ill the applicant or future building occupant handle hazardous material or
Applicant_ u, _Ddte I U fob,h�I are containing hazardous material equal to or greater that the
- amounts specified on the Hazardous Materials Information Guide?
in
WARNING:F-,.UKETOF REWO1.......aa.UNIPENSATIONCOVERAGEIS 0Yes leiro
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND GVIL FINES UP TOONE 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(SCA.QMD)75ee permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTOitNEYS FEES forguidel0'
CONSTRUCTION LENDING AGENCY OYes 0No
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 Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 h ardous material reporting.
Business and Professions Code).Any city or county that requires a permit to Y ONo )0I*r7
construct,alter,improve,demolish or repair any structure,prior to its _Date
issuance,also requires the applicant for the permit to rile a signed statement PROPERTY OWNER OR ORIZEDg1>Liv r'�
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINirNG(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 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 residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penaQ'of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
❑1,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 envsv.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-SOD-424-LEAD(5323).
Code;The Contractors State License law does not apply to an owner of a 0An EPA Lead-Safe Certified Renovator will be responsible furthis 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 '
completion,the Owner-Builder will have the burden of proving that it was Firm Certification No.':
not built or improved for the purpose of sale. O No EPA Lead-Safe Certified Firm is required for this project bemuse: `
111,as owner of the property am exclusively contracting with licensed
contactors to construct the project(Section 7044,Business and Professions
Code:The Contactors 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
Menifee
DATE: PERMIT/PLAN CHECK NUMBER O— 'v1i-F�s3
TYPE: O COMMERCIAL O 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 O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK GRL U " <-& Kb9fiFA fx1'L^CS.mFu r
PROJECTADDRESS 2 �J i+`U-< V1� OOD ZIP
ASSESSOR'S PARCEL NUMBER
��— Loq o G/`?q LOT _ TRACT �- 1 S 7
/}�r OWNER NAME S , Ako A f v I
ADDRESS SAME AS JOBS/�I fTE
PHONE S� I) I IR L4D .,�` EMAIL
APPLICANT NAME
p,.�,� �I,cl-rtrlr.r F` fz S�JIt_C-5 � � /tv�� F-W-` tl
ADDRESS ' �ftNc A_5 rLo f�11�RH'CNR
PHONE 1 �6d 191� EMAIL
CONTRACTOR'S NAME RIGHTIME HOME SERVICES OWNER BUILDER? OYES C NO
BUSINESS NAME AIRS
ADDRESS 3030 MYERS ST RIVERSIDE CA 92503
PHONE 800 660 0675 EMAIL CCALHOUN@ARS.COM
CONTRACTOR'S STATES/LIC NUMBER 765074 LICENSE CLASSIFICATION C10 C20 C36
VALUATION$ -7 5" o SQ FT L SQ FT '7
APPLICANT'S SIGNATURE DATE S(z(a
ITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY:
PERMIT FEE SMIP GREEN
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92585 951-672-6777
www.ci tvofineni fee.us
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