PMT15-03242 City of Menifee Permit No.: PMT15-03242
_ 29714 HAUN RD. Type: Residential Mechanical
�CCEL/-' MEN IFEE, CA 92586
MENIFEE Date Issued: 1 0/2 012 01 5
PERMIT
Site Address: 25727 GEISLER RD, MENIFEE,CA 92584 Parcel Number: 339-261-017
Construction Cost: $11,800.00
Existing Use: Proposed Use:
Description of REPLACE 100,000 BTU FURNACE, 5-TON A/C, COIL AND REDUCT 10 SUPPLY RUNS, SAME
Work: LOCATION
Owner Contractor
BARBARA MEUNIER A R S AMERICAN RESIDENTIAL SERVICES OF
25727 GEISLER ROAD CALIFORNIA INC
MENIFEE, CA 92584 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9512769744
LORI YENULONIS License Number.765074
A R S INC DBA RIGHTIME SERVICES
3030 MYERS.STREET
RIVERSIDE, CA 92503
Fee Description OQt Amount I$)
Forced-Air or Gravity-Type Furnace or Burner 1 149.00
Air Handling/Condensing Units SFR 1 133.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Mechanical 1 14.10
$324.10
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_Pennit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from ficensure under the Contractors'State License Law forth,
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 li
Professions Code nd my[license is in full force and effect. which I must have resided for at least one year prior to completion c
License Class L' nse Nc. improvements covered by this permit, I cannot legally sell a structure that I haw
Expires Oe3(�_l Signature _ built as an owner-building if It has not been constructed in its entirety by license
contractors. I understand that a copy of the applicable law,Section 7044 of th,
WORKERS'COMPENSATION DECIA I N �91/1'� Business and Professions Code,is available upon request when this application i
<d \I submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury on a following arations:
I have and will maintain a certificate of consent of self-insure for workers' htto:llwww.leainfo.p.aov/calawhtml.
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
7 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 I have provided is correct. I agree to compl.
permit is issued.Myworkers'compensation insurance carder and policy number are: 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
Cartier rt .`]rd nt'fed prope for the inspection purposes.
Policy# to 2&=k Date
Pro Owner orAuthorized Agent
(This section need not be completed if the permit is for City Business License#
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 employ 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?
y\Code,I shall fordwith comply with
those
_Tprovisions. DYES lB'�Z
�PPi 4 DAtec ,v OSl-t_J Will the intended use of the building by the applicant or future building
��V„JJ occupant require a permit for the construction or modification from South
W FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND ❑YES KNO
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 ofof a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES A7 NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I 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 concerning
3097 Civil Code) hazardou�saterial reporting.
OWNER BUILDER DECLARATIONS YES f7 NO
I hereby affirm under penalty of perjury that I am exempt from the Contractor's OQV - p, Date 10'2fl' IS
License Law for the reasons)indicated below by the checkmark(s)I have placed PROP TY OWNER ORAUTHORIZ
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 EN NATION.REPAIR AND PAINTING(RRP[
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 firths 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.gov/lead or contact the National Lead Information Center at
❑ 1, 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 Firm 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).
❑ 1, as owner of the property an exclusively contracting with licensed ❑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
Acknowledgement.
i
4
BUILDING & SAFETY PERM1T/PLAN CHECK APPLICATION
e
Menifee
AdiI
ic
DATE b- - PERMIT/PLAN CHECK NUMBER
I
TYPE: O COMMERCIAL ORESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE O ADDITION O ALTERATION O DEMOLMON O ELECLRICAL VQMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK IC' TO I
!� I� 10 S l - S I
PROJECTADDRESS C}
ASSESSOR'S PARCEL NUMBER 3?JR-a(P I " t-1 LOT TRACT enifee
2 Building & S tety Dept.
OWNER NAME t!
ADDRESS/� 2 5-t o(. 5 !. OCT 2 0 2015
PHONE O'61-$11n -QLD5�. EMAIL ! 1 d
{ -
APPLICANT NAME - l
ADDRESS
PHONE CN! L I.IQ —�L—L L-P EMAIL
CONTRACTOR'S NAME - 1 LC(4PhA' NER BUILDER? O YE5 9MO
f
BUSINESS NAME • d.b(at �t. L�'t-Z' me �PXut CR.O
ADDRESS C fD5
i
PHONE A EMAIL MQW
CONTRACTOR'S STATE LIC NUMBER �(,�n —I LICENSE CLASSIFICATION ' '
VALUATION$ ,� Q-ypC9��� SO FT L SO FT
APPLICANT'S SIGNATUREIry
DEPARTMENT DLSM[BUTION I CRY OF MENIFEE BUSINESS LICEN ENUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN , $MIP X
AMDUNT
INVOICE 10 PAIDAMOUNT .10 OCASH OCHECK t{ 0cmorTCARD) VISA/MC
1
PLAN CHECK FEES PAID AMOUNT - 0CASH 0CHECKN OCREDITCARD) VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER . NOTARIZED LETTER O YES O) NO
I
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.usInspection Request Line 951!-246-6213
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