PMT16-02742 City of Menifee Permit No.: PMT16-02742
29714 HAUN RD. Type: Residential Mechanical
'CXCCELX—> MENIFEE, CA 92686
MENIFEE Date Issued: 08/2212016
P E R M I T
Site Address: 29105 PRESTWICK RD, MENIFEE,CA Parcel Number: 338-087-003
92586 Construction Cost: $15,914.00
Existing Use: Proposed Use:
Description of HVAC REPLACEMENT,4-TON COMPLETE SPLIT SYSTEM WITH DUCT WORK
Work:
Owner Contractor
JACK BARCELON A R S AMERICAN RESIDENTIAL SERVICES OF
29105 PRESTVVICK ROAD CALIFORNIA INC
MENIFEE,CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9512769744
CHRISTINA CALHOUN License Number.765074
A R S INC DBA RIGHTIME
3030 MYERS ST
RIVERSIDE,CA 92507
Fee Description Qtv Amount($
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 emors 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__PenrniLTempIate.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 Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and cs I am exem pt from licensure under the Contractoes State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class C-10 r-20 C 3 Lii;ease By my signature below I acknowledge that,except for my personal residence
Expires Ln 1 Signature( in which I must have resided for at least one year prior to completion of
PAO 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
ci I hereby affirm under pena ItV 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 req uest 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 www.leeinfo.ca.gay/calaw.htmi.
this permit Is Issued.
Policy III Date
a 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 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 an the property owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
L, — — building construction.I authorize representatives of this city or county to
Policy#-ILA%I bb(ip�b J 0 1 pires 1 J2 4-s6l enter the above identified property for inspection purposes.
An 1,
(This section need not to be completed is the permit r one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
m I certify that In the performance of the work for which this permit Is issued,
I shall not employ a ny persons In any ma imer so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compeWption 9"ions?Aection 3700 of the Labor
Code,I shall _Wcoh ovi Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
Applicant;!Z 79=Date j,0
WA R N 1 4 4A'l`LU R E TO 5 E 21U R RN COMPENSATION COVERAGE IS a Yes 01110
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE H LIN DRIED 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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ci Yes On
I hereby affirm that under the pena Ity 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) a Yes b4o
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCACMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&safe%Code,S ' 25505725534 concerning
Contractor's Ucense Law for the reason(s)indicated below by the hazapdpus terial re ng. pc99n
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 s [
�VX 7T��
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its
issuance,also requires the applicant for the permit to file a signed statement t5PP`1;P1_0VVNER ER A&KORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractoes state EPA RENOVATION,REPAIR AND PAINTING IRRPJ
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 ficensure receiving compensation for most work that disturbs paint in a pre-1978
a nd the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childca re facility to be RRP-certified firms and comply With
an Applicant for a permit subjects the applicant to a civil pena Ity of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
cs 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 I )all of or( )portion of the work,and the structure is www.epa.goy/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAO(5323).
Cocle;The Contractor's State License Law does not apply to an owner of a a An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,th rough 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 sa le. a No EPA Lead-Safe Certified Firm is required for this project because:
cs 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP role please fill out the RRP
Acknowledgement.
& SAFETY PERM IT/PLAN CHECK APPLICATION
Menifee
DATE ve- PERMIT/PLAN CHECK NUMBER ?mko - 0214a
TYPE: 'Q COMMERCIAL %p4KSIDENTIAL 0 MULTI-FAMILY '0 MOBILE HOME 0 POOL/SPA -)SIGN
SUBTYPE: C ADDITION C'ALTERATION 0 DEMOLITION C I ELECTRICAL >-WECHANICAL
0 RE-ROOF-NUMBER OF SQUARES
ONEW 0 PLUMBING
DESCRIPTION OF WORK '4 _rO n
Lxw> AAA -iC:)0 C�_ LA.D CN-
PROJECTADDRESS 2alL 7-9 %()'T 0�alros
ASSESSOR'S PARCEL NUMBER tPLS-(w1- w5 LOT TRACT
Menifee
OWNER NAME 0&1 safety Dept.
ADDRESS Z�)�%&,,CL- 06 2 2 Z016
PHONE EMAIL
APPLICANT NAME V%G._ �%O Vv� F1,9ceived
ADDRESS
PHONE "C> eL) EMAIL
CONTRACTOR'S NAME 9-',q W� OWNER BUILDER? ')YES>rCNO
BUSINESS NAME 611
ADDRESS 30 It "neh'-s 15� -
PHONE tfto Lp(QQj nto-j%_ EMAIL
CONTRACTOR'S STATE LIC NUMBER 'jt#IE; 6-7 (4 LICENSE CLASSIFICATION _r_J0 CZO
VALUATION $ 1:515 JL4 - �g FT 4:7 L SO FT
APPLICANT'SSIGNA;URE-//�V,�e,"'U- DATE Lz hLe
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT OCASH --CHECK# 0 CREDIT CARD VISA/MC
AMOUNT
PLAN CHECK FEES PAID AMOUNT OCASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 No DL NUMBER NOTARIZED LETTER 0 YES '�
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.Lis Inspection Request Line 951-246-6213
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