PMT18-03445 City of Menifee Permit No.: PMT18-03445
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE MENIFEE Date Issued: 07/11/2018
PERMIT
Site Address: 25851 SANDY LODGE RD, MENIFEE, CA Parcel Number: 339-053-009
92586 Construction Cost: $2,222.00
Existing Use: Proposed Use:
Description of REPLACE 40 GALLON GAS WATER HEATER IN SERVICE PORCH
Work:
Owner Contractor
REECCA THUNDERBURK A R S AMERICAN RESIDENTIAL SERVICES OF
25851 SANDY LODGE RD CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD#201
Applicant Phone:9012719700
JIM PHILLIPS License Number. 765155
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNU
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
Fee Description OQt Amount(sl
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 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 slated,a permit for construction under which no work is commenced within six
months after issuance,orwhere 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 licensed 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 o 1 am exempt from Iicensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class Gam_Ucensf li . By my signature below I acknowledge that,except for my personal residence
Expires �3 t^ Signatur in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION'OECLARA have built as an owner-builder if it has not been constructed in its entirety by
❑i herebyaffirm under q nalty per ury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a kPstifi ate 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 forwhich www.leeinfo.ca.gov/calaw.hbnl.
this permit is Issued.
Date
Policy#
PROPERTY OWNER OR AUTHORIZED AGENT
o I have and will maintain workers compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which ❑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 owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
/- with all applicable city and county ordinances and state laws relating to
Carrier "e-r �/ building construction.I authorize representatives of this city or county to
Policy#WA7(1;5D F63i Expires J D enter the above identified property for inspection purposes.
(This section need not to be completed is the pem4t is for one-hundred 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, � ��'3
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS UCENSE 11
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall fart ith c mp y i h ose rovisions. Will the applicant or future building occupant handle hazardous material or a
sir- /� mixture containiigg a hazardous material equal to or greater that the
Appli �. "' Date! [ amounts spec 'fled on the Hazardous Materials Information Guide?
ARNI :FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes tl.N.
N FUL,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 DOLLARS($100,000j,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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelin
CONSTRUCTION LENDING AGENCY oYes o
I hereby affirm that under the penalty of perjury there is a construction Will the props it building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boun ryofa school?
(Section 3097 Civil Code) 0 Yes o
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that 1 am exempt from the California He fth&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous o .
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes
Business and Professions Code).Any city or county that requires a permit to Date t l
construct,alter,improve,demolish or repair any structure,prior to its pERTY OWNER 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 Contractors State EPA RENOVATION REPAIR AND PAINTING(RRPI
License Law(Chapter 9(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 Iicensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7032.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant far 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
❑I,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 www.epa.gov/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 D An 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
❑No EPA Lead-Safe Certified Firm is required for this project because:
not built or improved for the purpose of sale.
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 a If your project does not comply with EPA RRP rule please fill out the RRP
—T �11� w c n - C�� Ackn wledgement.
1is.. I�ih!I_ RC' �/L'Q7,I&S4 Gi/•J��
ti SAFETY PERMIT/PLAN
• 1 APPLICATION
4
Menifee
DATE PERMIT/PLAN CHECK NUMBER -- O S
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA [-]SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑NEW [Z]PLUMBING [:]RE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK Replace 40 gallon gas water heater in service porch.
PROJECTADDRESS 25851 Sandy Lodge Rd
ASSESSOR'S PARCEL NUMBER 1�5M '05�5_L)I01 LOT TRACT
OWNERNAME Rebecca Thunderburk
ADDRESS 25851 Sandy Lodge Rd.Sun City,CA 92586
PHONE (561)714-6091 EMAIL
APPLICANT NAME X zn vet
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 LICENUMBER 765155 LICENSE CLASSIFICATION C36
VALUATION$ J FT L SO FT
APPLICANT'S SIGNATU DATE
DEPARTMENT DISTRI UT10N CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNI NGINEfRING FIRE GREEN SMIP O`O;1
INVOICE tt PAIDAMOUNT
AMOUNT • `� I 1 0CASH 0 CHECK N OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 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 951-246-6213
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