PMT18-04362 City of Menifee Permit No.: PMT18-04362
29714 HAUN RD.
MENIFEE,CA 92586 Type: Residential Plumbing
{MENIFEE MENIFEE Date Issued: 0 910 412 01 8
PERMIT
Site Address: 28164 HORIZON CT, MENIFEE, CA Parcel Number: 333-392-005
92584 Construction Cost: $2,000.00
Existing Use: Proposed Use:
Description of REPLACE 50 GALLON GAS WATER HEATER IN GARAGE
Work:
Owner Contractor
ROB ERT DE LA ROCHA A R S AMERICAN RESIDENTIAL SERVICES OF
28164 HORIZON COURT CALIFORNIA INC
MENIFEE, CA 92584 965 RIDGE LAKE BLVD#201
Applicant Phone: 9012719700
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNU License Number:765155
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
Fee Description Q1t�� Amount f8)
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 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_Pennit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
1 hereby affirm under penalty of perjury that
ith a licensed contractor(s)pursuant to the Contractors State License Law).
u
Chapter9(commencing with section 7000)of1 Divisiam rider provisions o on 3 ofth sr a o I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effe the following reason:
License Class c-No Ucense
By my signature below I acknowledge that,except for my personal residence
Expires 7i 0 Signature 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 DECLARATION 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 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 website:
by Section 3700 of the Labor Code,for the performance of work for which www.IeRlnfo.ca.Rov/caIaw.htmI.permit is issued.
Policy# Date
d)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 I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act an the prope wn alf.I have read this
number are: application and the InformatioZn "led is correct.I agree to comply
Carrier ( �- with all applicahle city aes and state laws relating to
f�2 9 Ier huilding canstru a atives ofthls dty or county to
Poliryg 765 Y% Expires IQII o enterthea led proection purposes.
(This section need not to be completed Is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of hich this permit is issued,
I shall not emoloV any persons i r so as to became subject to the CITY BUSINESS LICENSE p
workers compensation 1 r ' nd agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the work r provisions of Section 3700 of the Labor
Code,I shall f wi co plywit hose provisions. Will the applicant or future building occupant handle hazardous material or a
[7 L !Y' mixture containing a hazardous material equal to or greater that the
Apt Date _1 l amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No
UNLAWFUL,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($100,000),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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY o Yes o No
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 No
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
California Health al Safety Code,Section 25505 and 25534 concerning
Contractor's license Law for the reason(s)indicated below by the
hazardous material reporting.
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5
oyes o No
Business and Professions Code).Any city or county that requires a permit to Dale
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING(FIRM
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 Cade)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 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.eaa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80D-424-LEAD(5323).
Code,The Contractor's State License Law does not apply to an owner of a o 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
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project because:
❑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 RRP rule please fill out the RRP
Acknowledgement.
.RMAruvo
4�
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
it
Menifee
DATE PERMIT/PLAN CHECK NUMBER ( V 3 1-'
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA [-]SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION [-]DEMOLITION ❑ELECTRICAL []MECHANICAL
[]NEW ✓❑PLUMBING ❑RE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK Replace 50 gallon gas water heater in garage.
PROJECTADDRESS 28164 Horizon Ct HH
ASSESSOR'S PARCEL NUMBER 333'��2 'VCP3 LOT TRACT
OWNER NAME Robert De La Roche QtY of Menifee
ADDRESS 28164 Horizon Court, Sun City, CA 92585 Building Dept.
PHONE (951)760-0327 EMAIL SEP 04 2018
APPLICANT NAME alreell 4110-
ADDRESS 1520 W Linden Street Riverside,CA 92507
e
PHONE (951)341-9371 EMAIL
CONTRACTOR'S NAME ARS Rescue Rooter OWNER BUILDER? ❑YES❑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$ $2.000.00 L SQ FT ,7
APPLICANT'S SIGNATURE DATE 9 I B
C1rY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING CANNING ENGINEERING FIRE I GREEN I SMIP
INVOIC 1/�], PAIDAMOUNT
AMOUNT ^^ <'. CASH 'CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# ^CREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 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
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