PMT16-03219 City of Menifee Permit No.: PMT16-03219
29714 HAUN RD. Type: Residential Mechanical
<A—CCELA—> MENIFEE, CA 92586
MENIFEE Date Issued. 09129/2016
P E R M I T
Site Address: 27730 BARONI RD, MENIFEE,CA 92585 Parcel Number: 329-290-038
Construction Cost: $13,283.00
Existing Use: Proposed Use:
Description of HVAC REPLACE 5-TON COMPLETE SPLIT SYSTEM
Work:
Owner Contractor
DOUGLASDONAHUE A R S AMERICAN RESIDENTIAL SERVICES OF
27730 BARON[ROAD CALIFORNIA INC
MENIFEE, CA 92585 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9512769744
KENNY PERREY License Number 765074
A R S INC DBA RIGHTIME
3030 MYERS STREET
RIVERSIDE, CA 92503
Fee Description 9-ty 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
Additional Plan Review Mechanical 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 builiding operations being carried an 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_Penit—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 under penalty of perjury that I am under provisions of With a licensed contractor(s)pursuant to the Contractors State License Law).
Chapterg(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 affect the following reason:
UcenseClas! License No. J�56 7//
By my signature below I acknowledge that,except for my personal residence
Expires -11�- !gnatum '7 in which I mot 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 DECLARAMICIN have built as an owner-builder if it has not been constructed in its entirety by
,y.l 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 Pr'ofessions Code,is available upon request when
compensation,Issued by the Director of Industrial Rela dons as provided for this application Is submitted or at the followling website:
by Section 3700 of the Labor Code,for the performance of work for which vA-Av.leginfo.ce.goy/cala%v.htmI
this permit is issued.
Policy Date
ci I have and will maintain worker's compensation insurance,as required by PROPERTY OWN Ell OR AUTHORIZED AGENT
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 am: application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state law relating to
CarHer L—C building construction.I authorize representatives ofthis dtyorcountyto
policy#704ac) Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hun.dred Date
dollars($10D)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work forwhich this permit is issued, CITY BUSINESS UCENSE#
I shall not employ any persons in any manner so as to become subject to the 50OW o550
workees compensation laws of California,and agree that if I should become HkARDOLIS MATERIAL DECLARATION
subject to the worker's compensation provisions Of Section 3700 of the Labor
Code,I shall lorthw camplywit t osepromians. ill the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant 70 112 Al—/�).
� Ve A!±"4 l 090 ox 1��' . - . ( �cffied on the Hazardous Materials Information Guide?
WARNING:FAILURE TO S9CREWOR-W!5 COMPE UERAGE 15 a Yes ErNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the bull ding 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 pernritting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATI-OdNEYS FEES forgifidellnes
CONSTRUCTION LENDING AGENCY ciYes 5Mo
0
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0
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oc
0
Y
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8
I
u
for F
0 Ye
I hereby affirm that under the penalty of perjury there is a construction Vrill the proposed building or modified facility be within 10DO feet of tii.
W
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) 03 Yes alpe
OWNER BUILDER DECLARATIONS I have read the Hazardous Material information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
Ce .
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)indica led below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 DY ciNo 47 0
Business and Professions Code).Any city or county that requires a permit to e,11� Olt,
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER ORBPW0—R-11ED25E1qT—
issuance,also requires the applicant for the permit to file a signed statement
that he arshe is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING RRPI
License Law(Chapter 9(commanding with Secrion 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions code)or that he orshe is exempt from licemure recelvilng compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.S by residence or childcare facility to be RRP-certifted firms and comply with
an Applicant for a permit subjects the applicant to a Civil pena Ikof not more required practices.This includes rental property owners and property
than($500) managers who do the paint-disturbing work themselves or through their
E3 1,as owner of the property,or my employee with wages as their sale 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.gowflead or contact the National Lead Information Center at
not Intended or offered for sale.(Section 7044,Business and Professions J-HOO-424-LEAD(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 witld n 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 became:
a 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.
BUILDING SAFETY PERMIT/PLAN CHECK APPLICATION
O"Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE OCOMMERCIAL 6I�RESIDENTIAL -- MULTI-FAMILY 0— MOBILEHOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION 0ALTERATION 0DEMOUTION OELECTRICAL 61MECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS �)773C al;q12401-t1l A)FIVI 22C Czq �Z9-5L
ASSESSOR'S PARCEL NUMBER TRAq C'tyCfMen'f9e,,,,
OWNER NAME Aac,, Ix A�
L 6EP 2 9 2016
ADDRESS —f—/o JE�—
PHONE E�W, -c;Y 17 EMAIL Receive(JI
APPLICANT NAME
ADDRESS
PHONEC�b6 2 �, 60-6�7 EMAIL
CONTRACTOR'S NAME �K16 OWNERBUILDER? OYES)OPNO
BUSINESS NAME PI14;Ch r1t, 74E
ADDRESS
EMAIL
PHONE
CONTRACTOR'S STATE LIC NUMBER 7(-1,56 74 LICENSE CLASSIFICATION
VALUATION $ FT LSQ FT
APPLICANTS SIGNATURE DATE
CITYSTAFFUSE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP 70
INVOICE PAID AMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
AMOUNT 1204.10
PLAN CHECK FEES PAIDAMOUNT OCASH CICHECK# OCREDITCARD VISAIMC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityof,menifee.us Inspection Request Line 951-246-6213
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