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
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