PMT16-03003 City of Menifee Permit No.: PMT16-03003
29714 HALIN RD. Type: Residential Mechanical
<A_CCEO� MENIFEE, CA 92586
G'AMR—, MENIFEE Date Issued: 0910912016
P E R M I T
Site Address: 28409 SUN CITY BLVD, MENIFEE, CA Parcel Number: 335-302-036
92586 Construction Cost: $19,777.00
Existing Use; Proposed Use:
Description of 3 TON HVAC PACKAGE UNIT REPLACEMENT, RE-DUCT WORK 8 SUPPLIES, 1 RETURN
Work:
Owner Contractor
ROBERT SOKOL A R S AMERICAN RESIDENTIAL SERVICES OF
28409 SUN CITY BLVD CALIFORNIA INC
MENIFEE,CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9512769744
DAVID FERGUSON License Number:765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNb
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS,CA 38120
Fee Description Pik 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 errors in the plans and
specifications or from preventing bulliding 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.
AkB1dg_PermitTeMplate.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contraCtOT(S)pursuantto 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 a 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 ass 6t flo OL License No. 765iD21 By my signature below I acknowledge that,except for my personal residence
L 7DJ 1-1 ignature � 4 3��
Expires 5 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 �v 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 for worker's 7044 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.leginfo.ca.gay/calaw.htmi.
this permit Is issued.
7 Poll # Date
have nd will maintain wmk.,el, enripemticirt insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,forthe performance of the work for which a 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
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 I building construction.I authorize representatives of this city or county to
Policy# 14r)�%rlfom Expires 6� r30 :1 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
ci I certify that In the performance of the work for which this permit is issued, 0
I shall not employ 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 compensation provisions of Section 3700 of the Labor
Code,I shall forth�ith co those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILU;IE 4;ECURE WORKER'S COMPENSATION COVERAGE IS 0 Yes ;yNo
UNLAWFUL,AND SMALL 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 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 permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelln s
CONSTRUCTION LENDING AGENCY 0 Yes 20
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) 0 Yes 0,Nb
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 Health&Safety Code Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous material rep rting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 p6es ci No
Business and Professions Code).Any city or county that requires a permit to I Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER 0 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 R PA 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 exem ption.Any violation of Section 703 1.5 by resid ence or ch ildca re 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 orthrough their
ci 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 I all of or( I portion of the work,and the structure is www.er)a.gov/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 o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improv�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:
o 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.
& SAFETY PERMIT/PLAN CHECK APPLICATION
'Wenifee
DATE PERMIT/PLAN CHECK NUMBER %0
TYPE: OCOMMERCIAL 0,4(ESIDENTIAL OMULTI-FAIVILY OMOBILEHOME 0_ POOL/SPA OSIGN
SUBTYPE: CIADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES_
DESCRIPTION OF WORK PAC&kK Ujj
Z Doc" wfo(,-v,, � _wkf) I RJTLAI,�
PROJECT ADDRESS 51j rj (AT
ASSESSOR'S PARCEL NUMBER 50,45 <A*LOT TRACT
OWNER NAME �k'%U;T �,('LUL
ADDRESS (L19�o N
PHONE EMAIL
APPLICANT NAME
f
ADDRESS
PHONE vr), 610-1 EMAIL
CONTRACTOR'S NAME N 6-14 OWNERBUILDERZ 0YES,-_NP
BUSINESS NAME ),I 1�,cz�
ADDRESS 0 n
PHONE ��b __C�_7( EMAIL
CONTRACTOR'S STATE LIC NUIMBER LICENSE CLASSIFICATION 0
VALUATION$ (I , I—)I SO FT L SO FT
APPLICANT'S SIGNATURE A /kTZ—���DATE
Ar,Mft* -Aw,
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN 1100 SMIP
INVOICE () PAIDAMOUNT
LANOF —1. OCASH OCHECK# 0 CREDIT CARD VISA/MC
MOU T
PLAN CHECK FEES PAIDAMOUNT 0 CASH OCHECK# OCREDITCARD VISAIMC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZEDLETTER 0 YES 0 NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us inspection Request Line 951-246-6213
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