PMT19-00014 City of Menifee Permit No.: PMT19-00014
29714 HAUN RD. Type: Residential Plumbing
�f L•: MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued: 01/03/2019
PERMIT
Site Address: 28590 DEL MONTE DR, MENIFEE, CA Parcel Number: 337-202-014
92586 Construction Cost: $14,875.00
Existing Use: Proposed Use:
Description of REPLACE DRAIN LINES FOR BACK TO BACK BATHROOMS AND INSTALL 30 L FT LINER ON 3"
Work: SEWER LINE
Owner Contractor
LAURI HAGEMAN A R S AMERICAN RESIDENTIAL SERVICES OF
28590 DEL MONTE DRIVE CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD#201
Applicant Phone: 9012719700
JIM PHILLIPS License Number: 765155
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIi
965 RIDGE LAKE BLVD#201
MEMPHIS,TN 38120
Fee Description Qt( Amount{$}
Plumbing Fixtures and Vents, fixtures 116.00
Sewer 1 150.00
Building Permit Issuance 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing ? 1 13.30
$307.30
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_Permit_Template.rpt Page 1 of 1
Ulm 9KI11iP - A-05
CITY OF MENIFEE eecwa OAAU&
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 ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason: .......
I1 5 _
License Class►'- License No. By my signature below I acknowledge that,except for my personal residence
Expires I 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 DE6RAKfON have built as an owner-builder if it has not been constructed in its entirety by
❑1 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 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
this permit is issued. vjww.le info.ea. av Calaw.html.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
o I have and will maintain worker's 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 worker's 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
4
Carrier Ur— with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#s:a7 �75a�G3 Expires ro 11�'�� enter the above identified propertyfor 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
❑I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall farthwitFjca th rovisions. WIII the applicant or future building occupant handle hazardous material or a
jWA
plican - Date J7! mixture containing a hazardous material equal to or greater that the
amounts sp9dr,ied on the Hazardous Materials Information Guide?
I FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes ta'No
L FUt,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES WIII the intended use of the building by the applicant or future building
D CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ion occupant require a permit for the construct or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SC ion or See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guideline
CONSTRUCTION LENDING AGENCY Cl Yes
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 bou�ary of a school?
(Section 3097 Civil Code) ❑Yes r ❑
OWNER BUILD R DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements underthe State of
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the reason(s)indicated below by the hazardooNo
CalifornIth&Safety Code,Section 25505 and 25534 concerning riot reporting.
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 �! Q
construct,alter,improve,demolish or repair any structure,prior to its RAPER 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 Contractor's State EP ENOVATION REPAIR AND PAINT]NG 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 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.epa.aovllead 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 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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
o 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.
BUILDING & SAFETY PERMIT/PLAN CI-Ii CK APPI.ICA-;110N
DATE: &I lot PERMIT/PLAN CHECK NUMBER q
GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: 0, COMMERCIAL E) RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION 0 ALTERATION ®DEMOLITION ® ELECTRICAL ® MECHANICAL
®NEW (F)PLUMBING ORE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK Replace drain lines for back to back bathrooms and install liner
Ion 3" sewer line, 30ft.
OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERS O YES ONO
PROJECT ADDRESS 28590 Del Monte Dr ZIP 92586
ASSESSOR'S PARCEL NUMBER 331-ICQ LOT TRACT
OWNER NAME Lauri Hageman City of Menifee
ADDRESS
28590 Del Monte Dr, Menifee, CA 92586 Buti 1e
PHONE 440-666-3821 EMAIL j
i
APPLICANT NAME Q Cif eiV "0
ADDRESS 1520 W Linden St, Riverside, CA 92507
PHONE 951-341-9371 EMAIL
CONTRACTOR'S NAME ARS Rescue Rooter OWNER BUILDER? OYESCt)NO
BUSINESS NAME
ADDRESS 1520 W Linden St, Riverside, CA 92507
PHONE 951-341-9371 EMAIL
CONTRACTOR'S STATE LIC NUMBER 765155 LICENSE CLASSIFICATION C36
VALUATION$ 147875 SQ FT L SQ FT
APPLICANT'S SIGNATU DATE J f
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE 1 A
INVOICE TOTAL FGREEN 1 SMIP K
OWNER BUILDER VERIFIED ".)YES NO DRIVERS LICENSE# NOTARIZED LETTER C, YES <. NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
. �tiKr tad;tT
www.cityofmenifee.us
ENIF
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