PMT18-04519 City of Menifee Permit No.: PMT18-04519
29714 HAUN RD.
Jr MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE MENIFEE Date Issued: 09/17/2018
PERMIT
Site Address: 28080 NORTHWOOD DR, MENIFEE, CA Parcel Number: 337-161-002
92586 Construction Cost: $2,397.00
Existing Use: Proposed Use:
Description of REPLACE 40 GAL GAS WATER HEATER,SAME LOCATION INSIDE HOME
Work:
Owner Contractor
AURORA SCHRAGEN A R S AMERICAN RESIDENTIAL SERVICES OF
28080 NORTHWOOD DR 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 CALIFORNIi
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
Fee Description DIV Amount ISl
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 thereunderwhen 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_Permit_Template.rpt Page 1 of 1
S;(Y\ PKM i 5 5�,��`ACVCQ
CITY OF MENIFEE Q✓�JfAA F�fdC
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 perjurythat I am under provisions of
Chapter!)(commencing with section 7000)of Division 3 of the Business and n I 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 A-r^�- Ucense No. ?6.5_(S9� _ By my signature below I acknowledge that,except for my personal residence
Expires 3I Signature in which l must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that 1
WORKER'S COMPENSATION DE6L'APAADN have built as an owner-builder if it has not been constructed in its entirety by
D I hereby affirm under pea 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 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 carat the following website:
by Section 3700 of the Labor Cade,for the performance of work for which
www.leeinfo.ca.eov/calaw.h[ml.
this permit is issued.
Policyg Date
PROPERTY OWNER OR AUTHORIZED AGENT
D 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 an the property owners behalf.I have read this
numberare: application and the information I have provided is correct.I agree to comply
",(fie �-7� �Zj- with all applicable city and county ordinances and state laws relating to
Carrier / I building construction.I authorize representatives of this city or county to
Poficy RtJh?(� DSD, G31 Expires_�Q/])77/ enter the above identified property for inspection 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
D I certify that in the performance of the work for which this permit is issued,
I shall not amolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE
workers compensation laws of California,and agree that if I should became HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,1 shall forthwit rovisions. Will the applicant or future building occupant handle hazardous material or a
)icon `� Yv� Date mixture containing a hazardous material equal to or greaterthat the
A
PP '3, 1 amounts sp/ tRed on the Hazardous Materials Information Guide?
WA I .FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS oyes cl'No
U FUL,AND SHALL SUBIECfAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
D CIVIL FINES UPTO 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 OFTHE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guideline
CONSTRUCTION LENDING AGENCY Dyes o
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 bo�u�nff ary of a school?
(Section 3097 Civil Code) Dyes BT4o
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 perjurythat I am exempt from the Califomia He Ith&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardou vial reporting.
checkmark(s)I have placed next to the applicable Items)(Section 7031.5 oyes No
Business and Professions Code).Any city or county that requires a permit to Date 0
construct,alter,Improve,demolish or repair any structure,prior to its ;2!WNER 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 TION REPAIRAND PAINTING RRP
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 7031.5 by residence or chlldcare 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
Dl,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 1-800-424-EAD(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 forthis 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:
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
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION �V
ko
Meniiee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: [-]COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION []DEMOLITION [-]ELECTRICAL ❑MECHANICAL
[-]NEW OPLUMBING [IRE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK Replace 40 gallon gas water heater Inside home.
PROJECT ADDRESS 28080 Northwood Drive,Sun City, CA 92586 ^L'J
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME Aurora Schragen
ADDRESS 28080 Northwood Drive,Sun City, CA 92586
PHONE (951)264-1421 EMAIL
APPLICANT NAME �Y\
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$ $2,397.00 L SQ FT
APPLICANT'S SIGNATURE2=� DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBU CITY DF MENIFEEEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE Cj PAIDAMOUNT
AMOUNT 3x C% CASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES 0 NO
City of Menifee Building& Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofrnenifee.us Inspection Request Line 951-246-6213
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