PMT14-02242 1
City of Menifee Permit No.: PMT14-02242 I
�y 29714 HAUN RD.
'tCCEL-! MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 1
OB/21/2014
PERMIT
Site Address: 28394 PEBBLE BEACH DR, MENIFEE, Parcel Number: 337-193-002
CA 92586 Construction Cost: $8,995.00
Existing Use: Proposed Use:
Description of REPLACE 2.5 TON PACKAGE HVAC UNIT
Work:
Owner Contractor
MICHELLE HOLMES A R S AMERICAN RESIDENTIAL SERVICES OF
28394 PEBBLE BEACH DR CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant License Number: 791820
JANE RECKTENWALD
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIi
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Qtv Amount f$)
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 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
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 Code a d 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�s_License No. �g who builds or improves thereon, and who contracts for the projects with a
Expires Signature licensed contractor(s)pursuant to the Contractors State License Law).
a S A5
WORKERS'COMPENSATION DECLARATION
❑ 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 1 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
\Zll—�-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 Code, for the performance of the work for which this submitted or at the following Web site:httoi//www.lQqinfo.ca.ciov/calaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier �.t('JcJ—+-y- iU15. Property Owner or Authorized Agent Date
Expires'+- ��J '�`�� Policy#IQC"1
El By my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# 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-
. ❑ I 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 becomeF�"`l
subject to the workers'compensation provisions of Section 3700 of the Labor property Owner or Authorized Agen Date
Code, I shall forthwith comply with those provisions.
�Ap 4 A City Business License# �O—1 q
Date; 7 Applicant;
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, AYES 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 \0fNQ EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY T 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 ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address NO DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS / GUIDE LINES
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 ❑YES 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, 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 (Chapter 9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or ❑YES 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 (.'IVO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
El1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL fkEPORIING.
compensation, will do ( )all of or( ) porting of the work, and the structure is FIR 11 OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
I
CITY ,OF MENIFEE PLCK No: p it
29714 Haun Road !
D te:
Menifee. CA 92586 Date:
Phone: (951)672-6777 v °°"t A^°°^t
Fax:(951)679-3843 CR#: it
Building Combination Permit
To Be Com feted By Applicant
Legal Description: '1r_ Plannin Case:
R
Property Address: Assessor's Parcel Number.
28394 Pebble Beach Dr 337-193 002
ProjocVTenanl Name: Unit#: Floor#:
Name: Michelle Holmes Phe Fax No.
Property 9W1 19-5597
Address:Owner 28394 Pebble Beach Dr Sun City, Unit Number ZI
CA 92586 p Code 92586
Email Address:
Name: Phone No. Fax No.
Jane Recktenwals 4-3 6-6159
Applicant Address: Unit Number Zip Code
Email Address:
Name: ARS Phone�%1-280-3113 Fax No.
Contractor Address: City This Zip Code
1225 Graphite Dr na 92881
°35074 My tsusmess License Contractor's City Slat&of Caltromla License No. Classification:
C20/C36
Number of Squares:
Square Footage
Description orwark: Replace 2a/z ton package HVAC unit Cost or work
ign s
Applicant's Signature Dale 8.995.00
To Be Completed-BY,CIty'.$jatfOnlY 8-21-2014
;' :`. ...:,,,
Indicate As R-Received or WA-Not Applicable
5 Camplaics sets of fully dimensioned,drawn to sale plans which include: 1 set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Gee Tech/Soils Report(on cd only)
❑ Plot I Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 Y,x 11)
❑ Foundation Plan ❑ Structural Calculations
❑ Cross Section ❑ Plumbing Plan
Q Single Line diagram for elec.services over 400 AIV1P
❑ Floor Plan ❑ Structural Framing Plan&Bows ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate Now Construction Alteration• Addition• hfeany6felhods
Work Typo: Repair* Retrofit' Reolskn to Existing Pemtit' Requlred7 YES NO
Proposed Building Use{s} Existing Building Use(s):
Buildings: #Units: #Stories: Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate Indicate it YES or NO Indicate all Geo-tech.Haz.Zone
Completions
AI Project Construction Sprinklered that apply: Coastal Zone
Typetsy C Of D YES or NO Noise Zone
Reauiretl7 Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal commiss Arch.Review Board I Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt; Cily Project Elec.Vehicle Charger Landmark ISelsiruc Retrofit 5Por1,11 call Bids
Omciat Acmavai
Expedite Project(s): Child Care Cily Project Green Building I Landmark Allurdabie Housing
Far Stnrf Use Only
I - riy I Pernii�5vtciaiisi I CCy f':anai^Q I f.• P ,ng-_
l 1
THANK YOU FOR HELPING US CREATE A BETTER COPah1UNITY
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