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PMT15-03182 City of Menifee Permit No.: PMT15-03182 29714 HAUN RD. 'tACCEL/-> MENIFEE,CA 92586 Type: Residential Mechanical MENIFEE Date Issued: 10/1412015 PERMIT Site Address: 26286 FOXGROVE RD, MENIFEE,CA Parcel Number: 338-023-006 92586 Construction Cost: $3,958.00 Existing Use: Proposed Use: Description of REPLACE 80,000 BTU FURNACE&COIL Work: Owner Contractor SHIRLEY QUICK A R S AMERICAN RESIDENTIAL SERVICES OF 26286 FOXGROVE ROAD CALIFORNIA INC MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201 Applicant Phone: 9512769744 LORI YENULONIS License Number:765074 A R S INC DBA RIGHTIME HOME SERVICES 3030 MYERS STREET RIVERSIDE, CA 92503 Fee Description QQtt( Amount f$1 Forced-Air or Gravity-Type Furnace or Burner 1 149.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Mechanical 1 7.45 $184.45 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_Peonit_Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ 1 am exempt from licensure under the Contractors'State License Law for th, I hereby affirm under penalty or perjury that I am licensed under provisions of following reason: Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence ii Professions Cod and my license is in full force and effe p which 1 must have resided for at least one year prior to completion c License Class Code, op CAb L cense No. �''1 improvements covered by this permit, I cannot legally sell a structure that I haw Expires Signature built as an owner-building if it has not been constructed in its entirety by license( qf� contractors. I understand that a copy of the applicable law, Section 7044 of IN WORKERS'COMPENSATION DECLARA I - O "'x Business and Professions Code,is available upon request when this application is submitted or at the following Web site: ElI hereby affirm under penalty of perjury one the following declarations: httii:// w.lecinfo.ce.gov/calaw html. I have and will maintain a certificate of consentt of self-insure for workers' compensation,issued by the Director of Industrial Relations as provided for by Date Section 3700 of the Labor Code, for the performance of work for which this permit is issued. Property Owner or Authorized Agent Policy# ❑ By my Signature below, I certify to each of the following: I am the propert; 'X I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read thi: section 3700 of the Labor Code, for the performance of the work for which this application and the information 1 have provided is correct. I agree to compl, permit is i sued My workers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to bulldim construction.I authorize representatives of this city or county to enter the above �Ca�rriPerntified ro 1perty fo e inspection purp Paoi #�(2�j!•.�jb�(Q�Jl�(�Expires l4• l•-�(G ate ^) ^)S Prope er or Authorized Agent p(This section need not be completed if the permit is for City Busi ' ense# "l one-hundred dollars($100)or less) ❑ I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION shall not enrol ov any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a workers'compensation laws of California. and agree that if I should become mixture containing a hazardous material equal to or greater that the subject to the workers'compensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide? Code,1 shall forthwith comply with those provisions. c DYES , NO �ip' Date; ^f �" 1 7 Will the intended use of the building by the applicant or future building �Qyr�.�' occupant require a permit for the construction or modification from South WA I FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist COM SATI N COVERAGE IS UNLAWFUL, AND SHALL for guidelines SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES RIND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school? LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES ,91NO CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAOMD 1 hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of agency for the performance of the work which this permit is issued (Section California Health&Safety Code,Section 25505 and 25534 conceming 3097 Civil Code) hazardous material reporting. OWNER BUILDER DECLARATIONS YES ZINO I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date I b S License Law for the reason(s)indicated below by the checkmark(s)I have placed P PER WNER OR AUTHORIZED AGENT next to the applicable item(s)(Section 7031.5. Business and Professions Code: Any city or county that requires a permit to construct alter, improve, demolish, EPA R OVA ON,REPAIR AND PAINTING fRRP1 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 The EPA Renovation,Repair and Painting(RRP)Rule requires contractors provisions of the Contractor's State License Law(Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978 Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit: www.epa.govAead or contact the National Lead Information Center at ❑ I, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(5323). compensation,will do( )all of or( )porting of the work, and the structure is 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 ❑An EPA Lead-Safe Certified Renovator will be responsible for this project who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, Certified Finn Name: 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 Firm Certification No.: purpose of sale). ❑ I, as owner of the property an exclusively contracting with licensed El No EPA Lead-Safe Certified Firm is required for this project because: contractors to construct the project(Section 7044, Business and Professions Code:The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who contracts for the projects with a licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP Acknowledoement. BUILDING & SAFETY PERMIT/PLAN APPLICATION s Menifee,�F DATE ©— y�VS PERMIT/PLAN CHECK NUMBER — TYPE: O COMMERCIAL ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL. )VMECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK O PUP r\aC2 PROJECTADDRESS OL(0-`a-b(v '�0 rCve, ` oad Soh 4 ASSESSOR'S PARCEL NUMBER 33'b I()a----5 ' W(D. LOT TRACT 0,,,, 11 OWNERNAME �� �\X' - �� Qjv, ADDREStS,, �0`c�- r V Z SU-YA C-L ` % PHONE�Q'h�p - nR - °l lQ( l `_EMAIL `--' APPLICANT NAME 6 C�]1 11 %n-k Xb ':w\1l ADDRESS 2>03 -PX's v-e r aa�o3 PHONE gcJ�'2�LP'`3�\-l'� EMAIL m L 10 IF ILw , CONTRACTOR'S NAME P+ Q - '% Q \,S1 �lOWNERSUILDER? OYES4NO BUSINESS NAME S�J 1Z'R,A Oka' Cl\ 'I l `!Y`Q \ \Vwvp, �*Xv l C4 ADDRESS : +\ k-o-V`L. 'b,� W V m 1115 381� PHONE b ^ a-I(p OF7� EMAIL '(r � Ytl� L CONTRACTOR'S STATE LIC NUMBER -11nc�)C TI LICENSE CLASSIFICATION C8o' C 40' C O VALUATION$ J \5 ' SO FT L SQ FT APPUCANT'S SIGNATURE — DATE C17-Y STAFF USE ONLY DEPARTMENT DISTRIBUTION CITYOFMENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAIDAMOUNT AMOUNT ` OCASH OCHECKO OCREDfT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT OGLSH OCHECKM OCREDITCARD VISA/MC OWNER BUILDERVERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES 0 NO City of Menifee Building&Safety Department 29714 Houn Rd.Menifee, CA 92596 951-672.6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 A n p o o p p c n a v a n a w In Z i. 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