PMT15-01579 i
City of Menifee Permit No.: PMT15-01579
29714 HAUN RD. Type: Residential Mechanical
AWCCEL MENIFEE, CA 92586
MENIFEE Date Issued: 0 611 012 01 5
i
PERMIT
Site Address: 26134 SHADYWOOD ST, MENIFEE, CA Parcel Number: 335-423-014
92586 Construction Cost: $4,090.00
Existing Use: Proposed Use:
Description of REPLACE 2.5 TON AC UNIT&DISCONNECT BOX
Work:
Owner Contractor
JOSEPH GUERRERO A R S AMERICAN RESIDENTIAL SERVICES OF
26134 SHADYWOOD ST CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9512769744
LAURA YENULONIS License Number: 765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIi
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description City Amount
rv^ '^'�^'°i'-9z,....,�,.T+-xi* ,e.-•�}s'wY"r`�' **�.'.y"`�'z,9µ,,'�°'c F.�'�`�^T^' 5 �� � ra,�..ff«,..,,.„,
Air Handling/Condensing Units SFR 1 133.00
�-
GREEN FEE 1 1.00
$277.00
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
f City Of Menifee
i
' LICENSED DECLARATION
I hereby affirm under penally 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�anTd my license is in fulUorrc and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class Licen e No. ll Li 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).
WORKERS'COMPENSATION D L 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:
p 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
FI 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
�,TI 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:http I/www.lQainfo.ca.Clov/calaw.htm].
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier k \ 1 `\ Property Owner or Authorized Agent Date
Expires \n-\-k—1 S W Policy# r,C' (1031 r)rNo )Li
Name of Agent Wyk (� Phone# U' -1.lrJ-�J�a', ❑ 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-
El 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 become .-tt;-IS
subject to the workers'compensation provisions of Section 3700 of the Labor property, er or Authorized Agent ^ Date
Code,I shall forthwith comply with those provisions. c^
, ` City I ne cense#
Date; ut—��'�� Applicant;
WARNING: FAILURE TO S URE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS U FUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMI L 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 A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES e0NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that underthe 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 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, -PNO 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 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 ,B'NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION 25505, 25533 AND 25534 CONCERNING
El 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORI1ING.
compensation,will do ( )all of or( ) porting of the work, and the structure is PRO TY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code; -
The Contractor's Stale License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
I
BUILDIN & SAFETY PERMIT/PLAN CHECK APPLICATION
t 0f Men ifee enif G
building
DATE PERMIT/PLAN CHECK NUMBER
® �O COMMERCIAL RESIDENTIAL , MULTI-FAMILY 0 MOBILE HOME " POOL/SPA O SIGN
R P.C e 1 V G I ADDITION O ALTERATION O DEMOUTION O ELECTRICAL yMECHANICAL
�/�i NEW OPLUMBING 0RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Re lace 2'% ton A/C unit & disconnect box
PROIECTADDRESS 26134 Shadywood St (�
ASSESSOR'S PARCEL NUMBER 335-423-014 LOT H TRACT1�'
OWNER NAME h Guerrero
ADDRESS ,26134 Shaduwood St Sun Citv, CA 92586
PHONE 916-612-1566 EMAIL N
APPLICANT NAME jag vX \ m2 S VI (NU�unISQ�
ADDRESS /.�
PHONE -1SI -a1(p-9'-74�JEMAIL r
CONTRACTOR'S NAME RI htime Home Services OWNER BUILDER? CI YES. NO
BUSINESS NAME
ADDRESS t Riverside CA 92503
PHONE 951-276-9744 EMAIL 5b C YQ5 �� �'1�Yt"Q SQYV I CPI7,
CONTRACTOR'S STATE LIC NUMBER 765074 LICENSE CLASSIFICATION 20 36
VALUATION$ 4 090,00 SQ FT L SQ FT
I
APPLICANT'S SIGNATURE _ DATE
DEPARTMENT DISTRIBUTION CYIY F IF S NSE NUMBER
SUIEDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE 60 PAIDAMOUNT _
AMOUNT t'1 CASH D CHECK R O CREDIT CARD VIWMC
PLAN CHECK FEES PAIDAMOUNT p CASH O CHECK K 0 CREDIT CARD VISA)MC
OWNER BUILDER VERIFIED OYES .^D NO OLNUMBER NOTARIZED LETTER �.! YES C' NO
City of klenifee Ouildincg&Scpfefy Department 29714Haan Rd Menifee, CA 92586951-672-6777
wwwcityofrnenifee,us Inspectiarr Request tine 951-246-6213
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