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PMT15-01115 City of Menifee Permit No.: PMT15-01115 29714 HAUN RD. 4�i : E..A?"' MENIFEE, CA 92586 Type: Residential Mechanical smmrvwx svi""*" MENIFEE Date Issued: 04/29/2015 ' PERMIT Site Address: 29420 THORNHILL DR, MENIFEE, CA Parcel Number: 338-061-018 92586 Construction Cost: $8,505.00 Existing Use: Proposed Use: Description of HVAC CHANGE OUT,4-TON 16 SEER SPLIT SYSTEM Work: Owner Contractor LAFIERCE SYARSH A R S AMERICAN RESIDENTIAL SERVICES OF 29420 THORNHILL DRIVE CALIFORNIA INC MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201 Applicant Phone: 9512769744 LAURA YENULONIS License Number: 765074 A R S INC DBA RIGHTIME HOME SERVICE 3030 MYERS STREET RIVERSIDE, CA 92503 Fee Description ,O�t Amount($1 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 i 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 and my license Is in full force and effect. :n lu Code:The Contractor's License Law does not apply to an owner of a property License Class� —Lice se No' �Q who builds or Improves thereon, and who contracts for the projects with a Expire&n 1G Signature, . licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION D CL ATION ❑ 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 Section 3700 of the Labor Code, for the performance of work for which this which I must have resided for at least.,one year prior to completion of permit is issued. improvements covered by this permit, I cannot legally sell a structure that I have Policy# built as an owner-building if it has not been constructed in its entirety by licensed contractors.if 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 ection 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto7/www leginfo ca gov/calaw html. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier ���'_ ""-4- Property caner or Authorized gent Date Expires �' 1 -�� Policy#IA=.VZBLI�Q ��\Qt Lf - - Name of Agent, (}2� C2L\ Phone#11f`LVaf 'j �(,� I ❑ By my Signature below, I certify to each of the following: I am the property 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 emolov 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 Code,tl shall forthwith comply with those provisions. Property 0 rAuthorized Agent Date Date; '1''—Cl"1 (�.� App -licant; L�,♦;j City Busines e# WARNING: FAILURE TO S CURE WORKERS' COMPENSATION COVERAGE IS: �NLA FUL, AND SHALL HAZARDOUS MATERIAL DECLARATION SUBJECT AN EMPLOYER TO CRIME PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING ($100,000), IN ADDITION TOTHE COST OF COMPENSATION, pYES 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 F 2-NO EQLAL 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 3097 Civil Code) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE Lender's Name ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT O 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 pYES 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, f5NO 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 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 Iicensure 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 Zp O UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than ($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING El 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL I}EPOR'1'ING, compensation,will do ( )all of or ( ) porting of the work., and the structure is PRO ERTY OWNER OR pI,1THORIZED AGEN not intended or offered for sale.(Section 7044,Business and Professions Code; - The Contractor's State License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the improvements are not Intended or offered for sale.If,however, the building or improvement Is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). SAFETYBUILDING & PERIMIT/PLAN CHECK ai ♦ LICATION jih Y PATE —\ cj PERMIT/PLAN CHECK NUMBER 5— \ TYPE: COMMERCIAL . RESIDENTIAL MULTI-FAMILY 1� MOBILE HOME :f POOL/SPA SIGN SUBTYPE: ':ADDITION C ALTERATION C DEMOLITION -- ELECTRICAL 4."IGIECHANICAL NEW C PLUMBING t, RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK �y�_Sc I S%cP1m v PROIECTADDRESS �ar-� 'C. ASSESSOR'S PARCEL NUMBER 2� Q\g LOT TRACT 9 BUlldin &D Safet Menite _ OWNER NAME � �. � � Gj 'Dept. APR ADDRESS O`VI y `� CDr Yl 1�, `S� Sux\ COq6 �p--{-1 5 PHONEA�\���\�� -d EMAIL '— eceIV APPLICANT NAM ADDRESS PHONE G1 ��'a-iL�-�'1�.,�t� EMAIL S CONTRACTOR'S NAM/^E� Rlghtime Home Services OWNER BUILDER? +YES,/NO BUSINESS NAME ly l rL�Q,• �\ ���v.-:O ,YrO �Y �� ,A ADDRESS Riverside CA 92503 PHONE -951-276-9744 EMAIL CONTRACTOR'S STATE UC NUMBER 74_ LICENSE CLASSIFICATION 1 0 36 VALUATION$ SOFT _ �k4l )0 L5QFT APPUCANT'SSIGNATURE — DATE �T ,r1S CfTYSTAFF USE ONLY DEPARTMEM DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBED BUILDING PLANNING ENOINEERING FIRE GREEN l SMIP )C INVOICE AMOUNT PAIDAMOUNT _ ''CASH CHECK It CREDITCARD VISA/MC PLAN CHECK FEES ( PAID AMOUNT -- CASH CHECK R -CREDIT CARD VISA/MC. OWNER BUILDER VERIFIED ))YES '- NO DL NUMBER NOTARIZED LETTER '-- YES NO n Cl N D Y 3 r m v 3 o z n A A + a d 0a7 A A mN - 3 m ° °- o m c m C N o rt N O m a N 7 �' N OG A Onl D D '"• 2 ➢ Q V N O N N T N 3 » Z N j g c 1 L N w 3 o » •� N A �_ p- M tO N N N N •° P Gl •N`C T O O 00 n N A O N n S 3• A n •.� C6 d N n _ n — N m$ 13 y 6 �, ' v o• 0 6f o m m � n�i » 0 3 Q < S _ _ T D d 9 N C d N a 3 N 3 m 3 ? m m n A w O N N Ir90 d N � O •.i S R "• ? d W = z O 6 m � d o '" 0 � — J 6 O V Lei N 4' 6 A w 3 A O aN A K A m O z � = w C �i Flo c. a D h✓! :Ci a �q m w O 4i1 N p� AD � 4 \o � Lo m N D O /n j • O W m n CD 3 �V CD a m z 3 KZ 6 OR Ap, 71 O 7110. Ice 9 ye st ur 0 m v 140.4 FL R R�l EL n IN i ! ggm AU mC g t, on IL m a 6 ti 31 F- i3 Sn 12 1