PMT16-03069 City of Menifee Permit No.: PMT16-03069
29714 HAUN RD. Type: Residential Mechanical
<A—CCELA> MENIFEE,CA 92586
MENIFEE Date Issued: 09/1612016
P E R M I T
Site Address: 28281 VIA CASCADITA, MENIFEE,CA Parcel Number: 336-322-021
92585 Construction Cost: $5,488.00
Existing Use: Proposed Use:
Description of REPLACE 2.5 TON A/C AND COIL ONLY, SAME LOCATION
Work:
Owner Contractor
WILMA KINZER A R S AMERICAN RESIDENTIAL SERVICES OF
28281 VIA CASCADITA CALIFORNIA INC
MENIFEE, CA 92585 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9512769744
DAVID FERGUSON License Number:765074
A R S INC DBA RIGHTIME
3030 MYERS STREET
RIVERSIDE, CA 92503
Fee Description Qty Amount($1
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
spedfications 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 BIdgPermit—Ternplate.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improvesthereon,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).
Chapter!)(commencing with section 7000)of Division 3 of the Business and m I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is In full force and effe"7 the following reason:
License Class z,[Lj((7o/c3& License .. k'15-71- By my signature below I acknowledge that,except for my personal residence
ILExpires ignature in which I must have resided for at least one year prior to completion of
4e%w improvements covered by this Perm it.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 u nder pena Ity 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 websfte:
by Section 3700 of th e Labor Code,for the performance of work for which
this permit is issued. www.leRinfo.ca.gov/czi1aw.btmI.
poll Y# Date
PROPERTY OWNER OR AUTHORIZED AGENT
I
Zh�,ave and will maintain workees compensation insurance,as required by
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
L"��fizv with all applicablecity and county ordinances and state laws relatingto
Carrier �30151)&3'0q Expires building construction.I authorize representatives of this city or county to
Policy# 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
o 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#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workhr's compensation provisions of Section 3700 of the Labor
Code,I shall ith those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant W Date ql(Of1t, mixture containing a hazardous material equal to orgreater that the
—41 amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE SECURE WORKER'S COMPENSATION COVERAGE IS oYes allo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AN 0 CIVIL FINES UP TO ON E HUNDRED THOUSAND DOLLARS($100,000),IN occupa nt 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 SECrION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY ci Yes o 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 perm it is issued outer boundary of a school?
(Section 3097 Civil Code) oYes nNo
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 reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes o No
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 PROPERTY OWNER OR AUTHORIZED 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 Contractoes State EPA RENOVATION,REPAIR AND PAINTING IRRP)
Uicense Law(Chapter 9(commencing with Sectilon 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 com ply with
an Applica nt for a permit subjects the applica nt 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
o 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( )all of or I )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-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a ci An EPA Lead-Safe Certified Renovatorwill be responsible forthis 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 itwas
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 RAP
Acknowledgement.
& SAFETY PERMIT/PLAN CHECK APPLICATION
wenifee
DATE PERMIT/PLAN CHECK NUMBERRMyo- rj5nL_o0t
TYPE: 0 C OMMERCIAL /0_`RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTR[CAL WMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK lotj ('0�s p �(,OIL OtJL� RcFrl"w-_tA cm ,
w,( botA ilof�
VkAr t'-lVADjj/)- 0(_ CItY of Menifee
PROJECT ADDRESS c415 8 4S BUIlding & SafetV n pt,
ASSESSOR'S PARCEL NUMBER
A'3Lfi— LOT TRACT SEP 15 201
OWNER NAME vilWAX -)��(Nj-LFJN,
ADDRESS el � 41 U(A AN.FNJY�rk C"31 125stceivec
PHONE 51) 6-A— 6 7 EMAIL
APPLICANT NAME FWD 1EAb0o j�)
ADDRESS '�c,-�c> "Ps T �X\j q2l[�G
PHONE �66-00� EMAIL
CONTRACTOR'S NAME 71F�\1,(41 T I iA f�_ HOMf S FPIUI(f OWNER BUILDEM? 0 YES IINC)
BUSINESS NAME
ADDRESS o3
PHONE (TOO) EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION ON (zo 16
VALUATION$ / g 1 , �Q FT L SO,FT
APPLICANT"l-SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN Smip I X
INVOICE
AMOUNT PAID AMOUNT L05 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH C)CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED C)YES 0 No DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92580'951-672-5777
www.CityOfmenifee.u5 InSPBCtiOn Request Line 951-246-6213
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