PMT15-01116 City of Menifee Permit No.: PMT15-01116
29714 HAUN RD. Type: Residential Mechanical
49kh Cal,-/- MENIFEE, CA 92586
MENIFEE Date Issued: 0412 912 01 6
PERMIT
Site Address: 28165 ORANGEGROVE AVE, MENIFEE, Parcel Number: 340-072-026
CA 92584 Construction Cost: $3,989.00
Existing Use: Proposed Use:
Description of R6 DUCT REPLACEMENT ONLY, 7 SUPPLIES, 1 RETURN
Work:
Owner Contractor
FRANCIS KEY A R S AMERICAN RESIDENTIAL SERVICES OF
28165 ORANGEGROVE AVE CALIFORNIA INC
MENIFEE, CA 92584 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9512769744
LAURA YENULONIS License Number: 765074
A R S DBA RIGHTIME HOME SERVICES
3030 MYERS STREET
RIVERSIDE, CA 92503
Fee Description Oft Amount
a$uUd g ermlf IIss�ance _ 1
. ,�, �..c�.. .,.na �1.,. .s..-w_ �.�-la, ....�. :..c
Inspections not specified 116 1116.00
$144.00
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_Templatesiot 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, cx
o an owner of a property
Code:The Contractor's License Law does not apply t '�I
License Class�,,'�� Lice se No."1�n �''� who builds or Improves thereon, and who contracts for the projects with a
Expiret �f�pS Signature r licensed contractors pursuant to the Contractors State License -�^ � �' ' � e Law).
WORKERS'COMPENSATION D CL ATION V
❑ 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 w rov I must
covered b this permit, I cannot legally sell i structure that have
permit is issued. P Y P 9 Y
Policy# built as an owner-building if it has not been constructed In its entirety by licensed
contractors.k ynderstand that a copy of the applicable law, Section 7044 of the
I have and will maintain workers' compensation Insurance, as required by Business and Prpfessions 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:http://w w.lgglnfo ca gov/calaw html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier �` p � - Property Owner or Authorized Agent Date
Expires \C—"l Policy#=I(ca
Name of Agent Phone ❑ 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-
❑ I certify that in the performance of the work for which this permit is issued, I identified property for the inspection purposes.
shall not emlov any persons in any manner so as to become subject to the -
workers' compensation laws of California, and agree that if I should become )ML '" 1
subject to the workers'compensation provisions of Section 3700 of the Labor Property O
Code,tI shall ffoorthwith�comply with those provisions. ro P KY ` r rAuthorized Agent (.' Date
Date r t -D Applicant; - . n,,.,,jJ City Businesslti e#
WARNING: FAILURE TO ''S CURE WORKERS' --- HAZARDOUS MATERIAL DECLARATION
-COMPENSATION COVERAGE IS.��[N LA FULL, AND SHALL
SUBJECT AN EMPLOYER TO CRIIVYt. - 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, ` ❑YES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES -aNO EWAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY d 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 I]YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
,,&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 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, "mo 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 OYES 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 .,FfgO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL I4tEPOR1 ING.
compensation,will ( )all of or( ) porting of the work, and the structure Is PRO ERTY OWNER OR 1THORIZED AGEN
not intended or offered for sale.(Section 04 Business and Professions Code; ..1'
The Contractor's State License Law does not apply to an owner of a property X i_ A V%
who, through employees' or personal effort, builds or improves the property, 1 0.
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the -
purpose of sale).
APPLICATIONN CHECK
} I
� c
DATE L\ - a a^ S PERMIT/PLAN CHECK NUMBER 5 - 61
TYPE: ,,COMMERCIAL RESIDENTIAL ' MULTI-FAMILY 4` MOBILE HOME ,,) POOLJSPA :`:�
SUBTYPE: ADDITION ALTERATION : fee
DEMOLITION 0 ELECTRICAL 41AECHANfNLIdin 9 & Saf dV-f DIG; ly Dept.
I
NEW O PLUMBING RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
cei ed
PROIECTADDRESS n1
ASSESSOR'S PARCEL NUMBER LOT LOT TRACT
OWNER NAME
ADDRESS
PHONE gcj�_ EMAIL
APPLICANT NAME
ADDRESS
t O
PHONE ��j r, .�'--iaq.- EMAIL 1
CONTRACTOR'S NAME RI htime Home Services OWNER BUILDER? YES VNO
BUSINESS NAME b 1 �� '1 S �(v
ADDRESS 3030 Myers St Riverside CA 92503
PHONE _95_1.276-9744 EMAIL !'
-Klld��-�5 �Lf1YS'�iWTp 7�1�U IL'.-<.F�
CONTRACTOR'S STATE UC NUMBER _765074 LICENSE CLASSIFICATION 1 2 36
VALUATION$ '5 1 SQ FT \?,, p L SQ FT
APPLICANT'S SIGNATURE MM DATE. 'A-o
CfTYSTAFF USE ONLY
J
DEPARTMENT DISTRIBUTION
CITY OF MENIEEE BUSINESS LICENSE NUMBER
BDftDiNG PLANNING ENG7N£ER1N6 FIRE GREEN SMIP X
INVOICE
AMOUNT — j PAIDAMOUNT _ --�
` ;,' CASH C%CHECK# =:'CREDITC9,R0 VISA1MC
PLAN CHECK FEES PAID AMOUNT I
- CASH CHECK N G CREDIT CARD VISAJMC
OWNER BUILDER VERIFIED YES NO DL NUMBER NOTARIZED LETTER YES NO
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