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PMT18-03246 City of Menifee Permit No.: PMT18-03246 29714 HAUN RD. Type: Residential Plumbing If® MENIFEE, CA 92586 MENIFEE MENIFEE Date Issued: 06/27/2018 PERMIT Site Address: 29399 GLENHURST CIR, MENIFEE, CA Parcel Number: 364-310-047 92584 Construction Cost: $3,800.00 Existing Use: Proposed Use: Description of REPLACE BACKFLOW DEVICE AND CLEAN OUT ON SEWER LINE IN FRONT YARD Work: Owner Contractor TIFFANY LOZANO A R S AMERICAN RESIDENTIAL SERVICES OF 29399 GLENHURST CIR CALIFORNIA INC MENIFEE, CA 92584 965 RIDGE LAKE BLVD#201 Applicant Phone:9012719700 JIM PHILLIPS License Number:765155 A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNb 965 RIDGE LAKE BLVD#201 MEMPHIS, CA 38120 Fee Description gty Amount 1$) Plumbing Fixtures and Vents,fixtures 1 116.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Plumbing 1 5.80 $149.80 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_81dg_Permit Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or Improves thereon,and who contracts for the projects I hereby affirm 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 a I am exempt from Iicensure under the Contractor's State Ucense law for Professions Code and my license is in full force and effect. the following reason: License Class aLicense No. By my signature below I acknowledge that,except for my personal residence Expires 00 Signature in which I must have resided for at least one year prior to completion of WORKER'S COMPENSATION D LA ION improvements covered by this permit.I cannot legally sell a structure that I have built as an owner-builder if it has not been constructed in its entirety by ❑I hereby affirm under pen of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section have and v411 maintain a certificate of consent of self-insure for worker's 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 website: by Section 3700 of the Labor Code,for the performance of work for which this permit is issued. www.leeinfo.ca.eovycalaw.html. Policy K Date cave 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 a By 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 owner or authorized to act on the property owner's behalf.I have read this number are: application and the information I have provided is correct.I agree to comply Carrierz,t with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy# L L26 Explres 14-/1/h, /� enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred Date dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT a I certify that in the performance of the work for which this permit is issued, I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE K worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the workers compemati rovisions of Section 3700 of the Labor Code,l shall fo ith campy h tho a provisions. / Willthe applicant or future building occupant handle hazardous material or Applican Date r2 mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? RN :FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS a Yes ❑No f WFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building ND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($500,000),IN occupant require a permit for the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.-AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMO)?See permitting checklist for guidelines CONSTRUCTION LENDING AGENCY ❑Yes ONo 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 Cwil Code) a Yes ❑No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD permitting checklist.I understand my requirements under the State of 1 hereby affirm under penalty of perjury that I am exempt from the C California Health&Safety Code,Section 25505 and 25534 concerning Contractor's License Law for the reason(s)Indicated below by the hazydious ma erial r porn p. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 N Business and Professions Code).Any city or county that requires a permit to Date construct,alter,Improve,demolish or repair any structure,prior to its PERTYOWNER OR AUTHORIZED AGENT 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 Contractor's Stat EPA RENOVATION.REPAIR AND PAINTING IRRPI License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repafrand 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 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 penalty 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 a 1,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,Business and Professions 1-ED0424-LEAD(5323). Code;The Contractor's 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: a I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RKP rule please fill out the RRP Acknowledgement. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION "Menifee DATE 06/27/2018 PERMIT/PLAN CHECK NUMBER ' 3� TYPE: ❑COMMERCIAL ❑d RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME POOL/SPA ❑SIGN SUBTYPE: []ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL [—I MECHANICAL []NEW ❑✓ PLUMBING ❑RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK Replace backflow device and clean out on sewer line in front yard PROJECTADDRESS 29399 Glenhurst Cir.Menifee Ca.925�8{4_�_ q ASSESSOR'S PARCEL NUMBER 3(p�l� �'O-b�F� LOT _ f� TRACT �ZZL OWNERNAME Tiffany Lozano ADDRESS 29399 Glenhurst Cir.Menifee Ca.92584 PHONE (949)636-9524 EMAIL APPLICANT NAME 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$ $3.800.00 L SQ FT APPLICANT'S SIGN//AT ..� DATE 06/27/2018 DEPARTMENT DI5TR19LafTN CITY OF MENIFEEEE BUSINESS UCEN NUMBER BUILDING PLANNING ENGINE RING FIRE GREEN (� SMIP - f / INVOICE PAIDAMOUNT AMOUNT I-' - OCASH OCHECK# OCREDIT CORD VISA/MC PLAN CHECK FEES PAID AMOUNT O CASH O CHECK k O CREDIT 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 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 zf3 29 6leAAurs'-1- CPr le sex otiy �� i�l Cite of Menii ee Building De t. JUN 2 7 2 18 Received cz, LU c.13i mamma LLM ll (22�1�e e CITY 0 MENIFEE ° c`2�1� BUILDII IG AND SAFETY DEPARTMENT Dee-&- 16,� jam' PLAN A PROVAL 04V SCLZ Qf REVI D B DATE 'Approval of these plans shall not betonstruedbbea permit for,oran FRctir �� approval of,any violation of any provisions of Me federal,state or city regulations and ordinances. This set of app(WMphns must be kept on the 1 1� jobsite until completion,