PMT18-03788 City of Menifee Permit No.: PMT18-03788
f�9 29714 HAUN RD. Type: Residential Plumbing
/ ® MENIFEE,CA 92586
MENIFEE MENIFEE Date Issued: 0 8101/2 01 8
PERMIT
Site Address: 28219 PANORAMA HILLS DR, MENIFEE, Parcel Number: 340-380-054
CA 92584 Construction Cost: $1,975.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE 50G GAS WATER HEATER IN GARAGE
Work:
Owner Contractor
BERNICE LEWIS A R S AMERICAN RESIDENTIAL SERVICES OF
28219 PANORAMA HILLS DRIVE CALIFORNIA INC
MENIFEE,CA 92584 965 RIDGE LAKE BLVD#201
Applicant Phone:9012719700
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIi License Number.765155
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
Phone: 9012719700
Fee Description Pity Amount
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_BIdg_Peonit_Template.rpt Page 1 of 1
ArAmw kon- �s
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contacts for the projects
I hembyaf&m under penalty of perjury that l am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law),
Chapter!)(commencing with section 7000)of Division 3 of the Business and a am exempt from licensure under the Contractor's State License Law for
Professions Code and my license Is in full farce and effect. the following reason:
License Cla;u;__C36 License No By mysignature below l acknowledge that,except forotypersonal residence
Expires NI Signature in which l must have resided for at least one year priertocomplelfon of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit I cannot legallysella structure that I
have built as an owner-builder IF It has not been canshucted in its entirety by
D 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 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 following wthsfle:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. vnvw.leeinfo.ca.eov/calmv.hlml.
Policy$1 Date
?have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
5ectfon 3700 of the Labor Code,for the performance of the work for which ca my signature helots l certify to each of the Folln6nig.I am the property
this permit is issued.My worker's compensation insurance carrier and policy caner or authorized to act on the property owner's behalf.I have read this
number are application and the information I have provided is corren.I agree to comply
Carrier Y with all I" city and coun ances and state laws relating to
buildingc start fi(.l auth representatives of this city or county to
Poliryg " d%( t Expires_ enter th Q erty for inspection purposes.
(This section need notto be completed Is the permit is f r one-hundred
dollars($100)or less Date 7
PROPERTY OWNER OR AUTHORIZED AGENT
certify that in the performance of the work for which this permit is issued,
I shall not employ any pets in any manner so to becomesuA,act to the CITY BUSINESS LICENSE
worker's compensation afC5Pma,a ree that Iflshauld become HAZARDOUS MATERIAL DECLARATION
subject to the wor- ns ion -ronsufSection 3700 of th Labor
Code,lshallfor Ath afi�����pi -wit rovj ions. Will the applicant at future building occupant handle hazardous material or
!% G mixture containing a hazardous material equal to orgreater that the
Applicant Oate amounts specified an the Hazardous Materials information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE Is Dyes No
UNLAWFUL,AND SHALLSUBIECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant at future building
AND CIVIL FINES UP TO ONE HUNDREDTHOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or meditation from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMDI?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY O Yes -crko,
hereby affirm that under the penally 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 Cade) DYes .moo
OWNER BUILDER DECLARATIONS I have
/read the Hazardou aterial Information Guldeand the SCAQMD
I hereby affirm under penalty of perjury that l am exempt from the the State of
permitting checklist. nder�st�'rl'my require underconcering
CaRromfa Healt Saf�ude,Sectinn and 25534 concerning
Contractor's License Law for the reason(s)Indicated below by the h�azardous erica rung.
cherkmark(s)I have placed next to the applicable ftem(s)(Section 7032.5 7ores 0
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,Improve,demolish or repair any structure,prior t0 its ROPERTYOWNER OR AUTHORREDAGENT
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 State EPA RENOVATION,REPAIR AND PAINTING IRRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRPj 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 70315 by residence or childcare facTty to he 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 ownersand property
than 000). managers who do the paint-disturbing work themselves or through their
01,as owner of the property,or my employee with wages as their sole employees.For mare information about EPA's Renovation Progman visit:
compensation,will do( )all of or( )portion of the work,and the structure is wwviceoa.eov/lead or contact the National Lead lnforrnathon Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80OA24-LEAD(5323).
Code;The Contractafs State License Law does not apply to an owner of a aAn 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. 0 No EPA Lead-Safe Certified Firm is required for this project because:
D 1,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 RRP rule please fill outthe RRP
Acknowledgement
SAFETYBUILDING & PERMIT/PLAN CHECK APPLICATION
y'... ..
Menifee
DATE PERMIT/PLAN CHECK NUMBER O —05-�
TYPE: ❑COMMERCIAL ✓❑RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA —]SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑NEW ❑✓ PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Replace 50 gallon gas water heater in garage
PROJECTADDRESS 28219 Panorama Hills Dr �i Lj
ASSESSOR'S PARCEL NUMBER �— 3p^CqOT TRACT
OWNER NAME Bernice Lewis V
CRY of Menitee
ADDRESS 28219 Panorama Hills Dr,Menifee, CA 92584 Building
PHONE (951)301-3922 EMAIL n .
II
APPLICANT NAME 41J Ds-C— klt-ep
ivedADDRESS 1520.W Linden Street Riverside,CA 92507 Rece
PHONE (951)341-9371 EMAIL
CONTRACTOR'S NAME ARS Rescue Rooter OWNER BUILDER? DYES❑J 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 Q L SQ FT
(s
APPLICANT'S SIGNATURE - DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN I SMIP
INVOICE 144W PAIDAMOUNT
AMOUNT O CASH O CHECK M O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# 0CREDIT CARD 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 92586951-672.6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
15 z OO (1 VI V
0 0 o d n a m M n ; m ppm >
C m N s m Z n m m £ g m � N h rt�
a m W A a 0 9i d d 0 d m .Ti ^ O
= m 1.
o 3 �' ->, .Q o. m a nSm
`e •7 `t o -o o a o w' �-� ' m Z
2 m r z m m
Z � Oprn
a g
m00
Cl) Co IQ
w o n m a o o m ip m w N m (D 1 m D
w' s n O n 1
J m g m N N 1p 3 D z m O
Mm
u w p ^• 3 o' n m 0 O• ry p1 O1 o A ^1 7 N N
3
•, JO 3 ». 3 J o m
N
3 3 J d 3
a m c a w cc -1 N M 2
>• .. N
2 0
N d 2 a O
OET m m O J 4 O N N
n
1, J J d N a N d GI
m p N' N T W
mm d m o y. �i it 0 3 oo F
d 3 '
ct
d d 2 d ID v N m N
3 N n - Q w
. n
N —
d v ti rA a pad x n
C
tNo 6 �i
4 ° - 3 3 m Sr0 J v
'�+ v n
n m p1 n F+
no
nC JJ C 6 £ P
m24
vi Z J .ar
ul o m v�i y m T a� m N ❑ ❑
N 4 4 o m J 3 m 7 c S # o
n
a.
m
0 4 N 6. d N G7 0 g d �c
Cy C �.�. � m � m jN ami -e w m m N
� a d £ m o o D = m o
3 °e9 7 n pJc 3 i
pp�� (p � m 4 N
o_ -gyp w ,d£+ ,n-�• °m' $, m o o m .°o3 � DA
Zmmm
6V
co
S m o F. m w Q c ro s v~i .❑y, m
.di T O 3 w N •A i
'° w 3
a o a = m
� lD N 'C '� T •V�1 A W N ,FH-` O �° W J 61 Vl A � n
^ a 1 a o d o m a �c .�^. x x z �+ 3 �` m z m D
v N D rt n N u9°i .Js n n a d m m
N An O T O o = ol` c m m 3 a s -y r m 5' v �n O
m m v a m 3• w e �, a p
`t "u 3_ w 9
� N � o x+ .air � °' 2 J � G D N = n .J* G Q A ,ny, r
.. v_ v N �^ ,`_l, m a m ° s T m 3 c �n
'° N ' -1 J o m J �mn N •G J a 7 o
m O 3
m,J. m
J m a
v m n M o n
z ET
v. a
o H' N. m m
o. c• .
EL
n n ELE, c ° n o m m v 3
a o ^ 5 y m j m
J
O a v E -
= w d o• � �r'4 m � 3 � J- s
fD n m J o v m
m ° rNr o� m7 3 O a � O m m
3
G e m -. ,
a c d
o m N 3 m
w c •• d A J o
0 a ? c s
� cCOii - a s 3 3
6
n d J
nDr
c
_J
CO V ° 1 n
o m m
W m n 3 ^ m a_ O
v, w o c o 3 m o inn
J c o 4 n
T ° H
m'
5 3 `p m1 w 3
n
W
O m H J P
d d a d 3 M
T N
D 0
J