PMT16-01813 City of Menifee Permit No.: PMT16-01813
29714 HAUN RD. Type: Residential Mechanical
�CCEF_A MENIFEE, CA92586
MENIFEE Date Issued: 0 6/1 312 0 1 6
PERMIT
Site Address: 31745 LIVINGSTON ST, MENIFEE, CA Parcel Number: 360-710-015
92584 Construction Cost: $36,555.00
Existing Use: Proposed Use:
Description of REPLACE 3 TON 21 SEER COMPLETE SPLIT SYSTEM
Work:
Owner Contractor
MELISSA LOWENSTINE A R S AMERICAN RESIDENTIAL SERVICES OF
31745 LIVINGSTON ST CALIFORNIA INC
MENIFEE, CA 92584 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9512769744
KENNY PEERY License Number: 765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORND
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Qtv Amount IS)
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 2.00
General Plan Maintenance Fee-Mechanical 1. 14.10
$325.10
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
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 contractor(s)pursuant to the Contractors State License taw).
Chapter9(commencing with section 7000)of Division 3 of the Business and a I am exempt from licensure under the Contractor's State License taw for
Professions Code and my license is in full force and effect. the following reason:
License ClasrL•�0J C ZpJ( _License No. 7G ,%71/ By my signature below l acknowledge that,except for my personal residence
Expires_ �C q'i ffnature in which I must have resided for at least one year prior to completion of
improvements covered by this permiL I cannot legally sell a structure that I
WORKER'S COMPENSATION DECIIIRATION have built as an owner-builder if it has not been constructed in its entirety by
jr.]hereby affirm under penalty of pe0'ury one of the following declarations:I licensed contractors.I understand thata copy of the applicable law,Section
have and will maintain a certificate of consent ofselMnsure 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 vnnv.leeinfo.ca.eov/calaw.h[ml.
this permit is issued.
Por1cy# Date
W 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 D By my signature below I 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
numberare: application and the information I have provided is correct I agree to comply
Cartier
LC� (� with all applicable city and county ordinances and state laws relating to
a building construction.I authorize representatives of this city or county to
PolicyflZQ50st 24 Expires so [7 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, O=-�7=J=r14
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# 1
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 forthw th comply with those provisions. ���� �� ill the applicant or future building occupant handle hazardous material or
Applicant Date-.��-k'+F-yam mixture containing a hazardous material equal to or greater that the
Y amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO S916REWORK S COMPENSATION COVERAGE IS ❑Yes
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL PINES 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 D)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY DYes ci
I hereby of imr 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) O Yes Oyd�
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
Contractors 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 items)(Section 7031.5 DY ONO Q
Business and Professions Code).Any city or county that requires a permit to �,QQ444 Date �1.✓
construct,after,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR ORI EDAGEM^—
issuance,also requires the applicant for the permit to file a signed statement C
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRPI
License Law(Chapter9(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 Sectioq 7031.5 by residence or childcare facility to be RRP-certNed firms and comply with
an Applicant fora permit subjects the applicant to a civil penaIWoF not more required practices.This includes rental property owners and property
than($500). managers who do the paint disturbing work themselves or through their
a1,as owner of the property,or my employee with wages as their sale 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 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. 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 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
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER -1'LO.- O 190
TYPE: O COMMERCIAL .O-RgIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
ONEW OOPPLUMBING ORE-ROOF-NUMBER OFSQUAREES
DESCRIPTION OF WORK ^- 1 O I CS�E� %/g- LS / 7- 5 r�
PROJECTADDRESS O/ /-( 5 4 % wow (,57 eie7 c4q /Idsgv
ASSESSOR'S PARCEL NUMBER ?,J(PO ',(O -Qk G J LOT AL� TRACT CA4
OWNER NAME A4 - Vc.X1 LOWS ,5%/�.�
ADDRESS
pp �/ 72S ' !� l / f-
/ OrJO
PHONE \ /cs/) C? • C�3( EMAIL
APPLICANT NAME �s� 6 n c C-CQ
ADDRESS 3O30 E/�^-� 4 ✓e72616e
PHONE �Q'/y�� ("y'4 C,.-in J S EMAIL
-c
CONTRACTOR'S NAME r �- L✓ OWNER BUILDER? O YES ONO
BUSINESS NAMEE
ADDRESS
PHONE ( $�J IQ(pO"(�p/S EMAIL
CONTRACTOR'S STATE LIC NUMBER 7 / /& y LICENSE CLASSIFICATION W6 C
VALUATION$ 4 SS5 SO FT C� L SQ FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION p CITY OF MENIFEE BUSINESS LIC NSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP 3SC
INVOICE IO PAIDAMOUNT
AMOUNT • 0CASH OCHECK# OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 4CHECK# GCREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES 0 NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building &Sofety Deportment 29714 Houn Rd, Menifee, CA 92586 951-672-5777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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