PMT14-02392 City of Menifee Permit No.: PMT14-02392
�`' , 29714 HAUN RD. Type: Residential Mechanical
Y-\Ca�.r'E�t.!-K MENIFEE, CA 92586
MENIFEE Date Issued: 09/05/2014
PERMIT
Site Address: 25802 SANDY LODGE RD, MENIFEE, CA Parcel Number: 339-052-019
92586 Construction Cost: $1,332.00
Existing Use: Proposed Use:
Description of DUCT WORK ONLY-ADDING 2 SUPPLY& 1 RETURN DUCT TO EXISTING HVAC SYSTEM
Work:
Owner Contractor
DONALD FURR A R S AMERICAN RESIDENTIAL SERVICES OF
25802 SANDY LODGE ROAD CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9012719700
LAURA YENULONIS License Number: 791620
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNh
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Phone: 9512813113
Fee Description 9-ty Amount isl
Inspections not specified 129 129.07
R
$157.07
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,orwhere the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Permit_Templatespt 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 and my license is in ful9r effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class ' -". License No. Z-G who builds or improves thereon, and who contracts for the projects with a
Expire % Signature, / ,p W. � licensed contractors)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION [A CL RATION
❑ 1 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
), 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:httn'//www.leginfo.ca.c;ov/calaw.htm-1.
permit is Issued.My workers'compensation insurance carrier and policy number are:
Carrier 1...-i
y Property Owner or Authonzed Agent Date
�Pk"�
Expires Policy
c., ❑ By my Signature below, I certify to each of the following: I am the property
Name of Agent Lod\CkcYx �7).Phone# p �y-, �-^[2?00, 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 emnlov any persons in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers'compensation provisions of Section 3700 of the Labor Prop'
O er or Authorized Agent ( Date
Code,I shall forthwith comply with those provisions.
(� City Business' eonse#
Date"1 — -.NL'` Applicant; —04 �_xn ��
WARNING: FAILURE TO S CURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNL FUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMI AL 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, OYES OCCUPANT HANDLE HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ONO 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 OYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable items)(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 (Chapter 9 (commencing with HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or OYES 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).) HAZARDOUS IONMAT 25505RIALff 5533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole
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 O MENIFEE a
PLCK No: Prmit No:
City of Menifee
29714 Haun Rokiidin9 a Safety Dept. - a
Menifee, CA 92586 SEP 0 5 2014 Date: p I l
Phone: (951}672-6777 ount: Amount:
Fax:(951)679-3843 Received 5�0�
Ck# Ck#:
Building Combination Permit
To Be Completed By Applicant
Legal Description: PlanningCase:
F: L: Rt; R:
Property Address: Assessor's Parcel Number.
a _
ProJecf/Tenant Name: Unit#: Floor#:
Name: Phone No. F Na
Property Pro e —
P Atldress:Owner Unit Number Zip Code
Email Address:
Name: h No.
x No.
Address — 8
Applicant nit Numbw Zip e
r'1
Email dress:
Nam -t ,I a No. x o.
5er'
Contractor dress: . V 6 -01 ao
\ City State Zi Code
ontractor 5 City BustTs License o. Contractor's it Late of Call omia Lice a No_
15 ClassiFicalian:
Numaer of Squares:
Square Footage
Description of Work: Cost of Work:
\ P
'c Ps Signatu
To Be Completed By Clry Staff Only
Indicate As R-Received or N/A-Not Applicable
S Comp s ets of fully diniens;-Qll drawn to sale plans which include: 1 set ofdocure nls which Include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on call only)
❑ Plot I Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8/x 11)
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Structural Calculations
❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing plan 8 Details ❑ Shoring Plan I ❑ Sound Report•Residential
Class Code: Indicate New Construction Alteration` Addition' I MeanstMethods
Work Type_ Repair" Retrofit` Revision to Fxis6ng Permfl'Requiredl YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories' Will the Building Have a Basement?
Y of N
Bldg.Cody.Occupancy Group Indicate Indicate it Indicate all Geo-tech.Haz.Zone
At Project Sprinklered YES or NO
Completion: Construction that apply: Coastal Zone
Type(s): C IN O Noise Zone
Relquiretl YES or NO l Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elea Vehicle Charger Landmark Seismic Retrofit apanat ase: lag
official royal
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
lauiltlinglSatety I Permit Specialist Ci'.y Panning Civrl En lneenng I EPWM-Atlm�n fransporlaliar.Mgml. I Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
D w n m W too o a w an o T n o m
0
� $
ZY
m tD m p m p1o, m m 9 3 d O
x
o rt w o 1 e
0 0 - o N c VNi N 9 '�•
m
w o 3 < a n -'i•- a ' o Z o 1D 3
n w O n
0 oa o n
w 3 n
_ z
n b0 O 3 T
�.r d lD C
O C A
N F x
< a
O N n ry d 3
O O n
•V G fC � -Y tlG N fD• ^ V o m a°o
m
A
3 �
N m a'
a m Ui
CD rr
ct
O ry O TAM
O O O �ryq\V ®CD
® N T
i
�t ryary m p Si", ,^N, o ^ m n n
LIT
Z N ry O n m rt N N , Er
x m
O N 77 a A o N h O O
EH
m a
IA u
El
C
° � Ew o p 7 Z
N
El
PL
o
6i N
a m
O- vv CL 3 fDi
02
A A
rho
7a N
o N
j kY N'
W �
'a O
61
a N
cr
N
p
N
C
O.
m F+
o O
� N
m in
a m
a x
N D
4 lA
f 9
n o 6HW N N 6H
m
A
N
,
; ! ; k ` .
K \ � / d �
- . / ( § �
\ } { � \ % �
9 J � \ ] .
{ { ( i /
! ; - ;
\ \ � � �
/ / . . � . § § �
� � �d � � \ \ �
; .
f � § �
, � � . _ / .
. . / � \ .
� ~ ^ � � \ \
���: _
\ ( . � � � .
. ® � ` \
� ( : � \ §
. \ \ - _ .
, f
e f �
� § °��/ %
� \ �y .
� ( /\ ,
� \ . �
� \ :
& 9
\ (
: 3 � £
\ \ / §
Y b m m o m o m m m v�i n 3 m E tj m m
n �
c m w DT. �• fP g d c m' 3, m a F, W Z y rt o O
° oy N m A >• rw O Ul m
Q N aEF . 7
ter° O °• ^ � w y7'
w rn A �. 8. _ryo Xaw a m rt � N R
4 el cr.
m o m S
w El
O m
0 ff G
r
C n 9
m caj�, a 3.,EC N
ia
m N fD v m o a
Q. �'m � 9 yr N ❑ (o a m c ro aG ^� v m Nu o
`" R .O
� � � m N 75 •Q` v_I � a a w a,' �-� m S .P c m rror
Li
Zj
�'.
C, yi
0 3
OR
Pro a o
" � o
N
i
tAn vl m ? M