PMT16-02743 City of Menifee Permit No.: PMT16-02743
A 29714 HAUN RD. Type: Residential Mechanical
<A—CCELA? MENIFEE, CA 92586
MENIFEE Date Issued: 0812212016
P E R M I T
Site Address: 27804 INVITATION DR, MENIFEE, CA Parcel Number: 331-393-013
92585 Construction Cost; $6,565.00
Existing Use: Proposed Use:
Description of REPLACE 3.5 TON COIL/CONDENSER ONLY
Work:
Owner Contractor
MICHAEL MARCOULIDES A R S AMERICAN RESIDENTIAL SERVICES OF
27804 INVITATION DR CALIFORNIA INC
MENIFEE,CA 92585 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9512769744
CHRISTINA CALHOUN License Number:765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNI)
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Qtv Amount
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 6.65
$167.65
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
spedifications or from preventing bulliding 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 Bidg_Permit Ternplate.ript 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 ci I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class 12.0 C'40 C-5(0 Licel)SeAo. —1111iso By my signature below I acknowledge that,except for my personal residence
Expires Signatureo) in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I ca n not 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
o 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 forworker's 7W 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 www.lesdnfo.ca.Rov/caIaw.htmL
this permit is Issued.
Policy If Date
o I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZEDAGENT
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.Myworkees 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
with all applicable city and county ordinances and state laws relating to
Carrier Llya-ie�4 building construction.I authorize representatives of this city orcounlyto
Policy#-11,45k 19 b8tob�()JqExpires 1124-s6i n enter the above Identified property for inspection purposes.
(This section need not to be completed is the permit islior one I,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,
lshallnotempl 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 become HAZARDOUS MATERIAL DECLARATION
subject to the worker'S competimption p;"ions cAection 3700 of the Labor
'it
Code,I shall va h C.
;�h s ov" Will the applicant or future building occupant handle hazardous material Ora
mixture containing a hazardous material equal to or greater that the
Applic Cate 817.7-11 Le amounts specified on the Hazardous Materials Information Guide?
WARNIN&�AILURETO SE�URA16RKER'S COMPENSATION C'0VERA'GE IS o Yes D4o
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 ON E HUN DRED 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 perm itting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUICrION LENDING AGENCY o Yes U440
1 hereby affirm that under the penalty of perjury them 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 04o
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Healt k&SafetyCode,SPzltpn 25505 25534 concerning
h
Contractor's License Law for the reason(s)indicated below by the hazapfpus terial re ng.111/
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 1
Business and Professions Code).Any city or county that requires a permit to �517e�
construct alter,improve,demolish or repair any structure,prior to its 6RPK&W'0-XNNERORA RIZED AGENT
Issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRPI
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 penalty 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
o I,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 I I all of or I )portion of the work,and the structure is www.ena.gov/lead or contact the National Lead Information Center at
not intended or offered for sa le.(Section 7044,Business a nd Professions 1-800-424-LEACi(5323).
Code;The Contractor's State License Law does not apply to an owner of a ci 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. a No EPA Lead-Safe Certified Firm Is required for this project because:
ci 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 rule please fill out the RRP
Acknowledgement.
z
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DA T I U PERM IT/PLAN CHECK NUMBER
CO
TYPE: Q MMERCIA0-�ESIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL '>kECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES-
DESCRIPTION OF WORK -S.49--raj-,
PROJECTADDRIESS zy .
ASSESSOR'S PARCEL NUMBER 6j 1P LOT TRACT
OWNERNAME MC%Y' ay-ral, wC1w,0II,,*-A
ADDRESS
PHONE(5NjQ2L9 R) 4j j 2- -'1308 EMAIL
APPLICANTNAME Ckv-i:j&,va-
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILIDEV 0 YES 0,�&
BUSINESS NAME
ADDRESS 3C>-4ib v- 5 Sv ?:Z v
PHONE 8bb Inca 71 EMAIL
CONTRACTOR'S STATE LIC NUMBER '71LIdS70-144 LICENSE CLASSIFICATION CIO CU C-6(0
VALUATION$ SO FT r L SO FT
I APPLICA DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION Tfk��OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING P"NNING ENGINEERING FIRE GREEN 1110 S7MIPT7
INVOICE -7 PAIDAMOUNT I I ()CREDIT CARD VISAIMC
AMOUNT I ((P .6;5' 1 OCASH OCHECK#
PLAN CHECK FEES I PAIDAMOUNT OCASH 0NCHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0- NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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