PMT16-03042 City of Menifee Permit No.; PMT16-03042
29714 HAUN RD. Residential Mechanical
<A—CCF—lLA—> MENIFEE,CA 92586 Type:
MENIFEE Date Issued: 09/1312016
P E R M I T
Site Address: 28430 SADDLECREST ST, MENIFEE, CA Parcel Number: 333-312-007
92585 Construction Cost: $19,594.00
Existing Use: Proposed Use:
Description of HVAC REPLACEMENT,2 3-TON COMPLETE SPLIT SYSTEMS
Work:
Owner Contractor
MELVIN CARTER A R S AMERICAN RESIDENTIAL SERVICES OF
28430 SADDLECREST STREET CALIFORNIA INC
MENIFEE, CA 92585 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9512769744
KENNY PEERY License Number.765074
A R S INC DBA RIGHTIME
3030 MYERS STREET
RIVERSIDE, CA 92503
Fee Description Qtv Amount(S
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 14A0
$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 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.Bidg_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 underpenalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter!3(commencing With section 7000)of Division 3 of the Business and ci I am exempt from licensum under the Contractoes State License Law for
Professions Code and my license is in full force and effecL the following reason:
License Clas! .CZ0 J4f.3( -7_6r,6C,3 74 By my signature below I acknowledge that,except for my personal residence
License No.
Expires n)t.% .mignature in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I can not legally sell a structure that I
WORKEWS COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
ehemby affirm under penalty of pedury one of the following declarations:I licensed contractors.I understand that a copy of the applkable lavv,Section
w1le and will maintain a certificate of consent of self-Insure for workees 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Bela Lions 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. w%-Aq.Ieginfo.ca.gov/calaw.htmI
Policy# Date
ci 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 ca rrier 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
Carrier With all applicable city and county ordinances and state laws relating to
Policy# building construction.I authorize representatives of this city or county to
enter the above identified property for inspection purposes.
Epi --t 0
. 3 ' - 1*7
(This section need not to be coml mni -hundred
dollars($100)or[us Date
PROPERTY OWNER OR AUTHORIZED AGENT
c;I certify that in the performance of the work for which this permit is Issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# 05567 �
workees compensation laws of California,and agree that If I should become HkZARDOUS MATERIAL DECLARATION
subject to the workerjs compensation provisions of Section 3700 of the Labor
Code,I shall forth J h comply With those provisions. . I lNill the applicant orfuture building occupant handle hazardous material ora
Applicant Aete,4 Afilvum Date xe containing a hazardous material equal to or gmaterthat the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SgCREWORKWS COMPENSATION COVERAGE IS Oyu Jawo—
UNLAWFUL,AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND aVI L FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTERESrG AND ATT09NEYS FEES Coast Air Quality Management District(SCAQMD)?See pernfltring checklist
forguidelines
CONSTRUCI-ION LENDING AGENCY ci Yes 13 No
C
c
a
Y
fo g
13 Ye
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) o Yes 01W
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guideand theSCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Ca
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting. - . Z
Business and Professions;Code).Any city or county that requires a permit to oY oNo Date
construMalter,improve,demolish or repair any structure,priarto its PROPERTY OWNER OftbVWO__RIIED��
issuance,also requires the applicant for the permit to rile a signed statement
that he or she Is licensed pursuant to the provisions of the Contractoes State EPA RENOVATION,REPAIR AND PAINTING(RRPj
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 Secticirl 7031.5 by residence or childare facility to be RRP-certilled firms and comply with
an Applicant for a permit subjects the applicant to a civil penalwoF not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
0 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( I portion of the work,and the structure is www.epa.govAead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD 15323).
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. o No EPA Lead-Safe Certified Finn is required for this project beca use:
E3 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 co mply with EPA RRP rule please fill out th e RRP
Acknowledgement.
110 Kai am I ma N k a
Menifee
DATE 9-/3 PERMIT/PLAN CHECK NUMBER 0?;04a
TYPE: OCOMMERCIAL ORESIDENTIAL OMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOUTION OELECTRICAL O— MECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
—�,2) -7-
DESCRIPTION OF WORK 2W 7
PROJECTADDRESSZ9
-:�, 3 cSA F-r, ki F-x-a R
ASSESSOR'S PARCEL NUM13ER LOT TRACT CITY 01 Menifee
MOU111V CA2?�r Building & Safety Dept.
OWNER NAME
ADDRESS SEP 13 2019
PHONE EMAIL
APPLICANT NAME 1-4�lclkl V Received
ADDRESS
PHONE 75 EMAIL
CONTRACrOR'S NAME OWNER BUILDER? 0 YES ONO
BUSINESSNAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER '76 LICENSE CLASSIFICATION
VALUATION SO FT L SO FT
Lima OL-J�� DATE 9-1-1)-.14A
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE 1 5j_ PAIDAMOUNT
AMOUNT P)!:A. 1C) I I 1 0 CASH 0 CHECK 4$ OCREDITCARD VISAINIC
PLAN CHECK FEES I PAIDAMOUNT I I OCASH OCHECK# OCREDITCARD VISAINIC
OWNER BUILDER VERIFIED C YES 0 No DLNUMBER NOTARIZED LETTER 0 YES C NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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