PMT16-02941 City of Menifee Permit No.: PMT16-02941
29714 HAUN RD. Type: Residential Mechanical
<A-CCF-LA? MENIFEE, CA 92586
MENIFEE Date Issued: 09102/2016
P E R M I T
Site Address: 27928 LEMONWOOD DR, MENIFEE, CA Parcel Number: 340-064-021
92584 Construction Cost: $3,000.00
Existing Use: Proposed Use:
Description of DUCT WORK ONLY R-6,8 SUPPLIES, 1 RETURN
Work:
Owner Contractor
CARMEN LANDELUIS A R S AMERICAN RESIDENTIAL SERVICES OF
27928 LEMONWOOD DR CALIFORNIA INC
MENIFEE,CA 92584 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9512769744
CARMEN LANDELUIS License Number: 765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNU
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Qtv Amount
Building Permit Issuance 1 27.00
Inspections not specified 116 116.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 5.80
$149.80
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA.Bldg_Perrnit-TeMp1ate.rpt Page I of 1
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Mr
enITee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL 'XRESIDENTIAL OMULTI-FAMILY OMOBILEHOME CPOOL/SPA OSIGN
SUBTYPE: CADDITION CALTERATION ODEMOLITION OELECTRICAL CIMECHANICAL
CNEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES_
DESCRIPTION OF WORK
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME A 5�Z4
ADDRESS
PHONE (9�30 ,5&6, - 73(:!� 7_ EMAIL
APPLICANT NAME Af
IADDRESS � 3CA-)
PHONE EMAIL
CONTRACTOR'S NAME OWNERBUILDER? OYESONO
BUSINESS NAME 7-1 lt4e--
ADDRESS
P H 0 N E 0 EMAIL
CONTRACTOR'S STATE LIC N LIM BER7656 -7-q LICENSE CLASSIFICATION C LL L
VALUATION$ SO FT L SQ FT
APPLICANT'S SIGNATURE— a,1k41ktJ DATE
CITYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION SMIP CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLAINNING ENGINEERING FIRE FGREEN
INVOICE I I PAIDAMOUNT
AMOUNT I I OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT I 1 0 CASH 0 CHECK# C'CREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 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
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improvo 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 E3 I am exempt from ficensure under the Contractoes State License Law for
Professions Code and my Rmnse Is in full force and effect. the following reason:
-2(
License Clas!elJeN.C2.o Jf 3(
License No. C5C)7q By my signature below I acknowledge that,except for my personal residence
Expires Cib
-LOIgnature
_n, a. inwhich I must have resided forat least one year prior to completion of
WORKEWS COMPENSATION DECLARATIO t N)— If :�!� improvements covered by this permit,I cannot legally sell a structure that I
d have built as an owner-builder if it has not been constructed in its entirety by
hereby affirm under penalty of pedury 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 requiast when
compensation,issued by the Director of Industrial Rela tions 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
this permit is issued. YA-Av.leginfo.ca.gov/calaiv.htmI
Policy# Date
o 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 ci 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 ownerjs behalf.I have read this
number are: application and the information I have proft6ded is correct.I agree to comply
CaMer with all applicable city and county ordinances and state laws relating to
buffl ding construction.I authorize representatives of this city orcountV to
Policy a 7A01-)DAI�U6 1� Expi enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
I i Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
a I certify that in the performance of the work for which this permit is issued, 7
1 shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# 0
workees compensation laws of California,and agree that if I should become ZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forth 'h comp y with those provi.sions. ill the applicant or future building occupant handle hazardous material or a
e44 Da mixture containing a hazardous material equal to or greater that the
Applica t 70,A.Z1 WO amounts specified on the Hazardous Materials Information Gukle?
� V-
WARNING:FA[WRETOStCHFIAIORWW�COMPFNSATICINCOVMGEIS 0 Yo 0-wo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIM INAL PENALTIES Will the intended use u�f the building by the applIca nt or future building
AND CIVIL FINES UP TO ON E 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(SCAQMD)?See pennitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST;AND ATroANEYS FEES forguldelines
CONSTRUCTION LENDING AGENCY oYes; .9,No
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) CI Yes 01pe
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
California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)Indicated below by the hazardous material reporting.
checkma rk(s)I have placed next to the applicable itern(s)(Section 7031.5 DY ONO
Business and Professions Code).Any City or county that requires a permit to eP AddLy Date
construct,alter,improve,demolish or repair any structure,priurtu its PROPERTY OWNER Oltg�MORIZED,�
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[RRP
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 Secticin 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 pemili�;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 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPXs Renovation Program visit:
compensation,Vill do I I all of or I I portion of the work,and the structure is vivimr.eria.goy/lead or contact the National Lead Information Center at
not intended or offered forsale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractorjs State License Law does not apply to an owner of a 13 An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal efifoM 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 Owrier-Bulkler will have the burden of proving that it was
not built or improved for the purpose of sale. EI No EPA Lead-Safe Certified Firm Is required for this project bemuse:
a 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractoes State License Law does not apply to an owner of a If your project does not co mply With EPA RRP rule please fill out th e RRP
Acknowledgement.
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