PMT14-02614 City of Menifee Permit No.: PMT14-02614
29714 Type: Residential Mechanical
MENIFEE,EE, CA 92586 C
MENIFEE Date Issued: 09/29/2014
PERMIT
Site Address: 27782 CANNON DR, MENIFEE, CA 92585 Parcel Number: 333-244-020
Construction Cost: $9,619.00
Existing Use: Proposed Use:
Description of REPLACE 75,000 BTU FURNACE, 3 TON 13 SEER A/C UNIT&COIL
Work:
Owner Contractor
JAMES GAYLOR A R S AMERICAN RESIDENTIAL SERVICES OF
27782 CANNON DR CALIFORNIA INC
MENIFEE, CA 92585 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9012719700
JANE RECKTENWALD License Number: 791820
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIi
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Qtv Amount
s ;
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 and 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 C;216 C'7;(c, License No.'1 1(k%3-0 who builds or improves thereon, and who contracts for the projects with a
ExpiresrrA rA15 Signature licensed contractor(s)pursuant to the Contractors State License Law).
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 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.
Policy# built as an owner-building if it has not been constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law, Section 7044 of the
❑ 1 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:htto'//www.loginfo.ca.ciov/calaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier
L&k 4y Property Owner or Authonze d Agent Date
"r 6
Expires 10_k-k4 Policy#
❑ 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-
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
subject to the workers'compensation provisions of Section 3700 of the Labor Property Owner or Autho' dent Date
Code,I shall forthwith comply with those provisions. t�
City Business License# 1
Date; �'')-�V_kq 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 OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES �0 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 ``❑Y�/E�� S A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address ENO FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
I/ 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 AYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s) (Section 7031.5. Business and Professions Cade: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, d0 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 AYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any cccc .���,,���� CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to �gdQO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORt NG.
compensation, will do ( )all of or( )porting of the work, and the structure is PROPERTY OWNER OR PlTRb
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
I
CITY 'OF MENIFEE
� PLCK No: P rmit No,•
29714 Haun Road Date: Date: ` r VT
Menifee, CA 92586 kacl I t
Phone: (951)672-6777 A"0°"" °°"" 7?IOw
Fax:(951)679-3843 Ckk: Ck$:
I
Building Combination Permit
To Be Completed By Applicant
L�dLegal Descriptiom� ,..- �Z Planning Case: F:
Property Address: °' Assessor's Parcel Number.
27782 Cannon Dr 333-244-020
ProjocVTenant Name: Unit k: Floor k:
James Ga for
Name: James Ga for 7�0Z2-2656 Fax No.
Property Address: Unit Number Zip Code
Owner 27782 Cannon Dr Romoland CA 92585 p 92585
Email Address:
Name: Phone No. Fax No.
Jane Recktenwald 714-336-6159
Applicant I Address: Unit Number Zip Code
Email Address:
Name: Phone No. Fax No.
28 0-3113
Contractor Address: DG�Orona State Zip Cade
1225 Gra hite Dr d 2881
ontractor's ty Esusmess license o. Contractor's City State of Califomla License No. Classification:
C20/C36
Number of Squares:
Square Footage
D scrip Ion of k: Cost of Work:S
seer A/C unit & coil
Applicant's Signature Dale:
< _ hTo-Be Compacted.By City_staff Only.
Indicale As R-Received or N/A-Not Applimbla
S Completes sets of fully dimensicned.drawn to sale plans which include: 1 set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on ed only)
❑ Plot I Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on B Y,x 11)
Foundation Plan ❑ Structural Calculations
❑ ❑ Crass Section ❑ Plumbing Plan ❑ Single Line diagram for else.services over 400 A,-,IP
❑ Floor Plan ❑ Structural Framing Plan&Detals ❑ Shoring Plan I ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addiiion' MeanyLlelhods
Work Typo: Repair' Relrogl' Reuisf:n to Existing Permit' Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
Buildings: !<Units: F Stories: Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate Indicate it Indicate all Gaodech.Haz.Zene
At Project Sprintlored YES or NO
Compietion: Construction that apply: Coastal Zone
Type(s): C Of I YES of PIO Noise Zone
Recuirotl? 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 Elect Vehicle Charger Landnnr'x Seismic Retrofit 'penal casa:mng
Olh<iai Auomv�l
Expedite Project(s): Child Care City Protect Green Building Landmark Affer,ab'e Housing
Far Slait Use Only
o6Ldle,,.o.i.+i/ Peron S,i.ua.,1 G.y Manning Lief f.mmnoar.nn ePb1.l Ada, I La nponi o rt. 1
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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