PMT15-02627 City of Menifee Permit No.: PMT16-02627
29714 Type: Residential Mechanical S
L MENIFEEEE,, C CA 92 92586
oms awmasa"'�° MENIFEE Date Issued: 0 8/2 712 01 6
i
PERMIT
Site Address: 27886 CLIFF TOP CT, MENIFEE, CA Parcel Number: 336-360-009
92585 Construction Cost: $15,000.00
Existing Use: Proposed Use:
Description of REPLACE 5 TON (16 SEER) SPLIT HVAC SYSTEM INCLUDING DUCT REPLACEMENT(5 SUPPLY
Work: RUNS, SAME LOCATION)
Owner Contractor
ALICIA CHANSY A R S AMERICAN RESIDENTIAL SERVICES OF
27886 CLIFF TOP CT CALIFORNIA INC
MENIFEE, CA 92585 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9512769744
LAURA YENULONIS License Number: 765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNb
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Foe Description 01tr Amount
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 building 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_Blug_Permit_Templato 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 Co e 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 Lice as N who builds or improves thereon, and who contracts for the projects with a
Expir `-�'Yh'\"-1 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
❑ I 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
❑ 1 have and will maintain workers' compensation Insurance, as required by Business and Professions Code,Is available upon requestwhen 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'iiwww.loginfo.ca.gov/calaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
- \ Property Owner or Authorized Agent Date
Carrier
Expires Policy# ''A(D J 150'6(Q 3L01
) ,,,-(,� '-1�J�J El By my Signature below, I certify to each of the following: I am the property
Name of Agent\ Phone#L o� ��J 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 r^^ .r
one-hundred dollars($100)or less) with all applicable city and county ordinances and state lP-s r-.,.,,,og to building
construction.I authorize representatives of this city or county to e1„u, ow 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 emolov any persons in any manner so as to become subject to the CC
workers' compensation laws of California., and agree that if I should become "- �--(�.J
subject to the workers'compensation provisions of Section 3700 of the Labor p opert f3 ner or Authorized Agent Date
Code, I shall forthwith comply with those provisions.
City Busin icense#
Date;�w'� l-�� Applicant; �1u -
WARNING: FAILURE TO S CURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS U FILL, 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, 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 ❑NO 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 OYES 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 ❑YES 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, ❑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 I HAVE READ THE HAZARDOUS MATERIAL
provisions of the Contractor's State License Law (Chapter 9 (commencing with
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 ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than ($500).) CODE SECTION
E 9 M T 25505,
50, 25533I AND 25534 CONCERNING
El 1, 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; td0/G�
The Contractor's Stale License Law does not apply to an owner of a property X Y
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).
---------------
7 r
CHECK APPLICATION
ee
Building & Safety Dept.
Menifee 2 7 2015
DATE 'aS' PERMIT/PLAN CHECK NUMBER 1 ( J o`�� 1
9
TYPE: O COMMERCIAL RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME O POOL/SPA O SIG � ��
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL )U MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
r
DESCRIPTION OF WORK 0 -C
PROJECTADDRESS �1,1-1 `C ��11��
ASSESSOR'S PARCELNU`MBER�J3Co '3\�0_O 'CX7`�1 LOT CT $,
OWNER NAME
ADDRESS
PHONE`�nY.S� -8�lO - �335 EMAIL
APPLICANT NAME Pc Q- T L ex O - gInL1I(,Tn
S
ADDRESS 3030 S
PHONE OLSk EMAILS
CONTRACTOR'S NAME OWNER BUILDER? OYES WNO
BUSINESS NAME
,, C,S
0.�
ADDRESS 5
PHONPI F 1 - a-I(p �"`��Lt EMAIL f\DSA�[%0 rv-0 V 1 Cgs-,
CONTRACTOR'S STATE LIC��..NU��MBER (DSO-1 ` UCENSE CLASSIFICATION
VALUATION SQ FT L SQ FT
APPLICANT'S SIGNATURE ATE—CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION fp CITY OF A9ENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN it SMIP
INVOICE of10 PAIDAMOUNT
AMOUNT O CASH O CHECK# CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# OCR£DITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www-cityofinenifee.us Inspection Request Line 951-245-6213
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