PMT14-02185 City of Menefee Permit No.: PMT14-02186
29714 HAUN RD. Type: Residential Mechanical
i60E1l, MENIFEE, CA 92586
MENIFEE Date Issued- 08/19/2014
PERMIT
Site Address: 26319 ALLENTOWN DR, MENIFEE, CA Parcel Number: 335-251-003
92586 Construction Cost: $8,409.00
Existing Use: Proposed Use:
Description of REPLACE 3-TON 13 SEER HEAT PUMP PACKAGE HVAC UNIT, SAME LOCATION
Work:
Owner Contractor
DEBRA KERNS A R S AMERICAN RESIDENTIAL SERVICES OF
26319 ALLENTOWN DRIVE CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9012719700
LAURA YENULONIS License Number: 791820
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNh
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Phone: 9512803113
Fee Description (3ty Amount f$1
Fwo ems, a`LV'T,, -F aGe B r UMMMlMEN, 9,:';
Air Handling/Condensing Units SFR 1 133.00
GREEN FEE 1 1.00
$310.00
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 staled,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_Templatexpl Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Co a an my license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class icense No. who builds or improves thereon, and who contracts for the projects with a
Expiresa•M-1S Signatur - licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION D A TION
❑ I am exempt from licensure under the Contractors'State License Law for the
❑ 1 hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in
compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have
permit is issued. built as an owner-building if it has not been constructed in its entirety by licensed
Policy# contractors. I understand that a copy of the applicable law, Section 7044 of the
FN I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
section 3700 of the Labor Cade, for the performance of the work for which this submitted or at the following Web site:http/1www.Ieoinfo.ca.gov/caIaw.htmI.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier__ �-
II -- �� Property Owner or Authorize Agent Date
�
Expires Policy#
❑ By my Signature below, I certify to each of the following: I am the property
Name of Agent k v,CY.,�-in C' .Phone#�,pL-Q 10-GJ"l -�30(l owner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
construction. I authorize representatives of this city or county to enter the above-
0 1 certify that in the performance of the work for which this permit is issued,I identified property for the inspection purposes.
shall not employ any persons in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become o M CJ ate
"l —1
subject to the workers'compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. P pe nor or Authorized Agent D
City Business icense#
Date; Applican ,
WARNING: FAILURE TO S CURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS U LA FUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIM L PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($700,000), IN ADDITION TO THE COST OF COMPENSATION, ❑YES OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES El NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ❑NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed AYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s)(Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, ❑NO SCHOOL?
or repair any structure, prior to its 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 License Law (Chapter9 (commencing with HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or DYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION 25505 25533,AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL�tEPOR1ING.
compensation, will do ( )all of or( )porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF ME' NIFE q� PLCK Na Permit No
29714 Haun Road �lypeat Date: �
Menifee, CA92586 �� -1q-1
Phone: (951)672-6777 % c`f11 "n Oent Amouni
Fax:(951)679-3843 ckn: ck :
Building Combination Permit
To Be Completed By Applicant
Legal Description: Planning Case: F: IL: Rt: R:
Property Address: \^ 1� Assessor's Parcel Number.
Projectimmant Name: Unit#: Floor k:
Name: \oy\ N - Fax No._,
Property Address: \ J nit Numbe91 r Zip Code
b 1 \
Email Atltlress:
tJ �
Name: \� ,r, - _ r1 t Ph No. ll Fax NZ
Applicant Address: K Unil Number Zip Code
1 1 �(
Email Ad eas: L ,
Phone No. Fax No.
S - (JA
Contractor Ad*30 s: �� \ 1S SI to Zip 1
ontractor s Ity BuS�ness L e e o. Contractor's Ci tat alifornia Licens No. ClassilicalionC L
Number of Squares:
Sq,are Footage
Description of Work: f\- _. wY , Cos!of Work:5
A tic n Signatur _ ^ 1 , Date: - O
1A \l
To Be Completed ity Staff Only
Indicate As R-Received or N;A-Not Applicable
5 Comple sets fully diment.oneQ drawn to sale plans which mdude. 1 se!of tlorumcros r+hich incbrdc
❑ Title Sheet ❑ Elevations ❑ Electrical Plan
❑ Gen Tech/Soils Report(on cd only)
❑ Plot I Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 2E Energy(on 8 Y:x 11)
Foundation Plan ❑ Structural Calculations
❑ ❑ Cross Section ❑ Plurnbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Preening Plan&Deti El Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition' Means7Methads
Work Typc: Repair• Ld Retrofit' Revision to Existing PermiC RegWrea? YES NO
Proposed Building Use(s): Existing Building Use(s):
tl Buildings: N Unis. #Stories Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate Indicate if YES or NO Indicate all Gea-tech.Haz.Zone
At Project Sprinklered
Completion: Construction that apply: Coastal Zone
Type(s). C"do YES or NO 1HINoise Zone
Required4 Listed on Historic.Resources Icventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elen.Vehicle Charger I.andmark Seismic Retrofit apron ,,,e ma9
elfitlnl Ao mvel
Expedite Project(s): Child Care City Project Green Building Landmark AHomame Ncusing
For Staff Use Only
i Dr ;mq/Solely t Pern&Specialist t Cry P arming ( G I Fng neenng - I F'WM-Admen '.�ansporlol qr Momt RAn
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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