PMT16-01791 City of Menifee Permit No.: PMT16-01791
29714 HAUN RD.
`�ACCELA7 MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Datelssued: 06/09/2016
PERMIT
Site Address: 28236 ENCINO DR,MENIFEE, CA 92586 Parcel Number: 336-272-030
Construction Cost: $16,659.00
Existing Use: Proposed Use:
Description of INSTALL 3 TON COMPLETE SPLIT SYSTEM 16 SEER
Work:
Owner Contractor
ROBERT&PATRICIA LEE A R S AMERICAN RESIDENTIAL SERVICES OF
28236 ENCINO DR CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9512769744
KENNY PERRY License Number:765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIi
3030 MYERS ST _
RIVERSIDE,CA 92503
Fee Description Oft t Amount(SI
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
$324.10
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee. Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bidg_Permit_Template.rpt Page 1 of 1
♦ 1 ♦ SAFETY PERMIT/PLAN
♦ 1 APPLICATION
.r
Menifee
DATE (Q q- PERMIT/PLAN CHECK NUMBER mT O I I
TYPE: O COMMERCIAL 01 ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OFSQUARES
DESCRIPTION OF WORK Co e iE- t7 50'4g t—
`'C �— /
PROJECTADDRESS 1J0 bL 1 C4k 5Sfe
ASSESSOR'S PARCEL NUMBER 33(o — 2_-1 I- 03Q'OT TRACT b3
OWNER NAME 'T' 4& fl SEE rr�-� /
ADDRESS ,3 I ' e 01 SS`P
PHONE f5( �"ja-y� � EEMAIL
APPLICANT NAME
ADDRESS p "Ve
TT ✓ � 1J �� ��
PHONE &)D �� �p(�'� (��p �� EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES ONO
BUSINESS NAME T� -7-
ADDRESS /rl /_ /C) h/�- �S / �I V c`'
PHONE ( a UV_) Lo 6 (mil-X 75 EMAIL
CONTRACTOR'S STATE LICCNUGM�'BER 765071 LICENSE CLASSIFICATION
VALUATION$ J /IQO SO FT �/ �' L SQ FT
APPLICANT'S SIGNATURE DATE 42
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION `` CITY OF MENIFEE BU51NL55 LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GRL`EN SMIP
INVOICE �^ r' PAID AMOUNT O
AMOUNT (i `' OCASH CHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# 0CREDIT CARD 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 951-572-6777
www.dtyofinenifee.Lis 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 mntractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑1 am exempt from licensure under the Contractor's State License taw for
Professions Code and my license its in full force and effect. J� the following reason:
License Clas!c_q C,&1 E03L-License No. _7(] fip Wr,ZT By mysignature below l acknowledge that,except for my personal residence
Expires---���gignature in which I must have resided for at least one year prior to completion of
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
v�I hereby affirm under penalty of perjury one or the fallowing 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 Cade,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 W,�v.leeinfo.ca.eov/alaw.html.
this permit is issued.
Policy#
Date
10 have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
Oction 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 worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number are: �7,,.,,,-f- application and the information I have provided is correct 1 agree to comply
Cartier 1 1 loS�l�l with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy It Expires So enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
Ishallnotemolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should becomeFle-u�
ARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,1 shall forthw h complywith those provisions. the applicant or future building occupant handle hazardous material or
Applicant Date ure containing a hazardous material equal to or greater that the
7' unts specified on the Hazardous Materials Information Guide.
WARNING:FAILURE TO S RE WORK S COMPENSATION COVERAGE IS es .e'1-UNLAWFUL,AND SHALLSUBJECfAN EMPLOYER TO CRIMINAL PENALTIES the intended use of the building by the applicant or future buRding
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN upant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR st Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES uidelinesCONSTRUCTION LENDING AGENCY s �qNoI hereby affirm that under the penalty of perjury there is a construction 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 r boundary of a school?(Section 3097 Civil Code) s 0�OWNER BUILDER DECLARATIONS ve read the Hazardous Material Information Guide and the SCAQMD
I herebyaffirm underpenalty of perjury that I am exempt from the itting checklist I understand my requirements underthe State of
Contractors License Law for the reason(s)indicated below by the rduu Health alSafety Cade,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 rdous material reporting.Business and Professions Code).Any city or county that requires a permit to 0No r Q 1
construct,alter,improve,demolish or repair any structure,prior to its ...Q11�in Date 7 L
Issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR Of�R12ED AGENT'
that he orshe is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IF—
License Law(Chapter 9(commencing with 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 penaltyiof not more required practices.This includes rental property owners and property
than($500). managers who do the paint disturbing work themselves or through their
O1,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 www.eoa.aov/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 Contractor's State License Law does not apply to an owner of a DAn 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. O No EPA Lead-Safe Certified Firm is required for this project because:
D 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractofs 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.
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