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PMT16-01547 City of Menifee Permit No.: PMT16-01547 29714 HAUN RD. '[;;�CCEIL MENIFEE, CA 92586 Type: Residential Mechanical MENIFEE Date Issued: 05/1712016 PERMIT Site Address: 28105 LEMONWOOD DR,MENIFEE,CA Parcel Number: 340-062-031 92584 Construction Cost: $6,702.00 Existing Use: Proposed Use: Description of REPLACE 1-TON MINI SPLIT HVAC SYSTEM,20 SEER Work: Owner Contractor LENA TERRY A R S AMERICAN RESIDENTIAL SERVICES OF 28105 LEMONWOOD DRIVE CALIFORNIA INC MENIFEE, CA 92584 965 RIDGE LAKE BLVD SUITE 201 Applicant Phone: 9512769744 KENNY PEERY License Number: 765074 A R S INC DBA RIGHTIME SERVICES 3030 MYERS STREET RIVERSIDE,CA 92503 Fee Description OQt r Amount I$) 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 carded 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 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractors)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and O I am exempt from licensure under the Contractors State License Law for Professions Code and my license Is in full force and effect) 56 -7 the following reason: License Class eU�a U.) CA License No. �(p ! By my signature below I acknowledge that,except for my personal residence Expires - fa:Oignature /_ in which I must have resided for at least one year prior to completion of WORKER'S COMPENSATION DECLARASMIONimprovements covered by this permit.1 cannot legally sell structure that I WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by �I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Code,is available upon request when compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website: by Section 3700 of the labor Code,for the performance of work for which this permit is issued. www.leeinfo.ca.eov/calaw.html. Policy It Date ❑I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which o By my signature below l certify to each of the following:I am the property this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this number are: application and the information I have provided is correct.I agree to comply Li t=��t27 U with all applicable city and county ordinances and state laws relating to Cartier_ building construction.l authorize representatives of this city or county to Policyg Expires — 1:Zi0 fZ enter the above identified property for inspection purposes. (This section need not to be completed is the permit its for one-hundred Date dollars($SOD)or less PROPERTY OWNER OR AUTHORIZED AGENT o I mrtify that in the performance of the work for which this permit is issued, I shall not employ any persons in any manner so as to became subject to the CITY BUSINESS LICENSE B J workers compensation laws of California,and agree that if I should become ZARDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 3700 of the Labor Code,I shall forthvi th comply with those provisions. ill the applicant or future building occupant handle hazardous material or a Applicant Date4/7- )14 mixture containing a hazardous material equal to orgreater that the Y amounts specified on the Hazardous Materials information Guide? WARNING:FAILURE TO S RE WORK S COMPENSATION COVERAGE IS ❑Yes .aft UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended useofthe building by the applicant or future building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant requires permit for the construction or madifia[ion from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant Quality Management DistrictonstS ction or modsSee moon ingfrom checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fargui it Quality CONSTRUCTION LENDING AGENCY aYes i o I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the lending agency for the performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) D Yes o� OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that l am exempt from the permitting checklist l understand my requirements under the State of Contractors License Law for the reason(s)Indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable item hazardous material reporting.$)(Section 7031.5 oY o No Business and Professions Code).Any city or county that requires a permit to pate construct,alter,improve,demolish or repair any structure,priorto its PROPERTY OWNER OR F�OR12ED AGELPr� issuance,also requires the applicant for the permit to file a signed statement L that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION..REPAIR PAINTING(RRPI License Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe The EPA Renovation,Repair and Painting(RRP)Rule requires contractors Business and Professions Code)or that he orshe is exempt from licensure receiving compensation for mostwork that disturbs paint in a pre-1978 and the basis for the alleged exemption.Any violation of Sectidn 7031.5 by residence or childcare facilityto be RRP-certified firms and comply with an Applicant for a permit subjects the applicant to a civil penalty of not more .required practices.This includes rental property owners and property than($500). managers who do the paint-disturbing work themselves orthrough their o1,as owner of the property,or my employee with wages as theirsole employees.For more information about EPA's Renovation Program visit: compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.eov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323). . Code,The Contractors State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project property who,through employees'or personal effort,builds or improves the property provided that the improvements are not intended or offered for Certified Firm Name: sale.If,however,the building or improvement is sold within one year of Firm Certification No.: completion,the Owner-Builder will have the burden of proving that it was not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Fun is required for this project bemuse: D I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement. APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK Menifee DATE `J^ _ l t7 PERMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL -el _ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL 'MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK E� PROJECTADDRESS VV�� ASSESSOR'S PARCEL NUMBER LOT TRACT 1 OWNER NAME Building & Safety Dept. ADDRESS p( a MAY I I 201 PHONE(,tj�� �p�� j EMAIL RUCTIVe APPLICANT NAME ��IU. ADDRESS/ ►'�/( Cj \ �Sf �fI"- PHONE( !90D) b160- 64p7: EMAIL CONTRACTOR'S NAME -��� (/�� OWNER BUILDER? O YES O BUSINESS NAME �` r !Mle_ !� ADDRESS \ E�-� ( K�1V�ILjI ��yy���� O .� PHONE ��+) 6 /P 6:6 75 EMAIL CONTRACTOR'S STATE LIC NUMBER /f 56 7? LICENSE CLASSIFICATION CLdj CLQ C VALUATION$ 6 -je a SQ FT z' L SQ FT JJ APPLICANT'S SIGNATURE DATE 7- Cl7 DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I GREEN I' SMIP INVOICE PAID AMOUNT AMOUNT �' O •�Q O CASH C%CHECK# J CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 _ 0 w , E $ > - } ( w ( _ � \ � ° f § ® � ® _ } f & § \ / Z » ® ® § \ , > 3 { ; , _ ® \ \ / \ � e ` 7 � 2 \ ® ] - rn \ } [ n . § ; £ e . ƒk ! ` \ § \ _ 7 ( ( ¥ ¥ E - ° oEL § ! {{ c ! , _ ® » 2 ®- , ® _ ~ } z _ RO \ / } - J / } / \ } � / \ ® \ m § i O m n n n o n D T RI N. 2 NNE Nc N G » m �--�wNo C pOp e0i< 3 3 N O O .r O O 3 ? 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