PMT16-01790 City of Menefee Permit No.: PMT16-01790
29714 HAUN RD.
S�CCEL/-> MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 0 610 912 01 6
PERMIT
Site Address: 26810 PINCKNEY WAY, MENIFEE, CA Parcel Number: 338-132-009
92586 Construction Cost: $10,219.00
Existing Use: Proposed Use:
Description of INSTALL 3.5 COMPLETE SPLIT SYSTEM 15 SEER
Work:
Owner Contractor
SOETJE(SUECHI)WOOLSEY A R S AMERICAN RESIDENTIAL SERVICES OF
26810 PINCKNEY WAY CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9512769744
KENNY PEERY License Number:765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNb
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description ON Amount t81
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
$324.10
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Permit_Template.rpt Page 1 of 1
i i SAFETY PERMIT/PLAN CHECK APPLICATION
Men'tee
DATE l ' PERMIT/PLAN CHECK NUMBER Q b
TYPE: O COMMERCIAL -9�,RESIDENTIAL O MULTI-FAMILY O MOBILE HOME 0 POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O. MECHANICAL
O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 3.5 I
PROIECTADDRESS CA 36
ASSESSOR'S PARCEL NUMBER 2 -a)�bT LA TRACT
OWNER NAMENA&)L501
C,
ADDRESS
PHONE EMAIL
APPLICANT NAME
ADDRESS p Ed2 T_ qR> �� ` �'E-
PHONE j�(p('- C) 75 EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 0 YES ONO
BUSINESS NAME
ADDRESS 7 Q E�SI
PHONE rQOD) EMAIL
CONTRACTOR'S STATE LIC NUMBER 7�g����/ LICENSE CLASSIFICATION
VALUATION$ I SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE
__ -
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN , SNIP
INVOICE q. L T PAID AMOUNT ,Y
AMOUNT 31.4 , 10 OCASH CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZEDLETTER 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 951-246-6213
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
With a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that 1 am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and O I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license isin full force and effect the following reason:
License ClasrC, am G2Q1G,7T License No. �� tN�7 By my signature below l acknowledge that,except for my personal residence
Expires / - 'S C/ /�/�ignature_ -t in which l must have resided for at least one year prior to completion of
fj
improvements covered by this permit I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
LAI 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 vnnv.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy# Date
Thave and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
cion 3700 of the Labor Code,for the performance of the work for which ❑By mysignature below l certify to each of the following:I am the property
this permit is issued.My worker's 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
L( �BI2-I -� with all applicable city and county ordinances and state laws relating to
Carrier building construction.l authorize representatives of this city or county to
Policy#70J RnRl alb f!/ Expires - 30 17 enter the above identified property for inspection purposes.
(This section need not to be wrap leted is the permit i for one-hundred Date
dollars($100)or less ii
PROPERTY OWNER OR AUTHORIZED AGENT
O I certify that in the performance of the work for which this permit is issued,
Ishailnotemolov any persons in any manner so as to become subject tothe CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become RDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthw'h complywith those provisions. III the applicant or future building occupant handle hazardous material or a
Applicant s ?Q AA Date1�._ 9-/_� amoure nts specified o hazardous matous al equal In or oboe Guihatde?
the
— i[[TM2'1'1�— Y amounts specified on the Hazardous Materials Information Guide.
WARNING:FAILURE TO S RE WORK: S COMPENSATION COVERAGE IS oyes
iavo-
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQM DR See permitting checklist
IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY ci Yes c
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) Dyes D,Nd'
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 DY o No Q 1
Business and Professions Cade).Any cityor county that requires a permit to r 7
construct,alter,improve,demolish or repair any structure,priorto its ey �� Date
PROPERTY OWNER OR ORI ED AGERI—'
issuance,also requires the applicant for the permit to file a signed statement L
that he orshe is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter9(commencingwith Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penaliy�,ofnot more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
D 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit
compensation,will do( )all of or( )portion of the work,and the structure is wvAv.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80D-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a oAn 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 Finn is required for this project because:
❑1,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 IMP rule please fill out the RRP
Acknowledgement.
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