PMT16-03493 City of Menifee Permit No.: PMT16-03493
29714 HAUN RD.
't:XCCELX—> MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 10/24/2016
P E R M I T
Site Address: 28299 SERENITY FALLS WAY,MENIFEE, Parcel Number: 333-590-013
CA 92585 Construction Cost: $16,879.00
Existing Use: Proposed Use;
Description of 5 TON COMPLETE SPLIT SYSTEM CHANGE OUT
Work:
Owner Contractor
LOUIS WILLIAMS A R S AMERICAN RESIDENTIAL SERVICES OF
28299 SERENITY FALLS WAY CALIFORNIA INC
MENIFEE,CA 92585 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9512769744
CHRISTINA CALHOUN License Number.,765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIj
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS,CA 38120
Fee Description Qtv 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 building 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 BidgPerrmt—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).
Chapter9(commencing with section 7000)of Division 3 of the Business and a I am exempt from licensure under the Contnctor's State License Law for
Professions Code and my license is in full force and effecL the following reason:
License Class Ctb C70 0 en;e�,-7�o�42 By my signature below I acknowledge that,except for my personal residence
Expires �6)_Ah7 Si=natur in which I must have resided for at least one year prior to completion of
k 599 sp��_�
WORKERS COMPENSATION DECLA ;0NZ Z::r'— Improvements covered by this permit.I cannot legally sell a structure that I
have built as an owner-builder If it has not been constructed in its entirety by
a I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applimble 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 welisite;
by Section 37UO of the Labor Code,for the performance of work for which
this permit is Issued. www.lagmfo.ca.RoyJcalaw.html.
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 a By my signature below I oertify 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 a re: , application and the Information I have provided is correct.I agree to comply
Carrier G OZA-1 with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Poficy# Las Lo Mpires Fi27*It 7 enter the above identified property for inspection purposes.
1. 1
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT Date
m 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 BU51NESS LICENSE# Lf
worker's compensation laws of California,and agree that if I should become
subject to the worker's oomperis . pr .'On'of Se 700 of the Labor HAZARDOU MATERIAL DECLARATION
Code,I shall f Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
'�EDatA70 Xv//'I—
ApDli :�� !�
— __ F__ amounts specified on the Hazardous Materials Information Guide?
AA G-F ET SE��REWORKERSOOMPENSATION?IDVE IdGEIS Dyes 0
W_�RNI :F T EC
UN S
UNLA .AND�SHALLSSUBJECTAN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARS($100,000),IN Will the intended use of the building by the applicant or future building
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
I N SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
for guidelines
CONSTRUCTION LENDING AGEN 0 Yes ko
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) a Yes 0—b—
OWNER BUILDER DECLARATIONS I have rea d 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 Hi
Contractor's License Law for the reason(s)indicated below by the uilth&Safety,"e,S io 25505 34 concerning
0
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 haze'au- al re
Business and Professions Code).Any city or county that requires a permit
construct,alter,Improve,demolish or repair any structure,prior to its to
77X7� '/ 7Dat.
issuance,also requires the applicant for the permit to file a signed statement t�R CIWJAUt�NT---
that he or she is licensed pursuant to the provisions of the Contractoes State 9.REPAIR AND PAINTING IRRP)
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 Section 7031.5 by
an Applica nt for a permit subjects the applim nt to a civil pena Ity of not more residence or childcare facility to be RRP-certifted firms and comply with
than($500). required practices.This includes rental property owners and property
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 sale employees.For more information about EP9s Renovation Program visit:
compensation,will do I )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
property who,through employees'or personal effort,builds or improves the a An EPA Lead-Safe Certified Renovator will be responsible for this project
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. a No EPA Lead-Safe Certified Firm is required for this preject bemuse:
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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
"Meni"
Tee
L7.IZA
DATE Iri Lo PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL >4-RESIDENTIAL 0 MULTI-FAMILY 0_ MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: 0 ADDITION 0 ALTERATION 0 DEMOLITION () ELECTRICAL 0 MECHANICAL
ONEW OPLUMBING �) RE-ROOF-NUMBER OF SQUARES
-7
DESCRIPTION OF WORK 0,0 nl� kZ�-C IS 42 vA-
�j&A-It III. lBvt
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER 1515�5 0 30T TRACT
OWNER NAME A1Mvvx<,,
ADDRESS Cl,�Uft--�
PHONE 57G(0-7 EMAIL
APPLICAN;NAME L*-A
ADDRESS !2ZI ,VL,,_32�
PHONE EMAIL
CONTRACTOR'S NAME (2- �4
k OWNERBUILDER? CYESD�'
BUSINESS NAME LI/
ADDRESS
PHONE 600 (a Le 0 0 Le-7 5�_ EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION (1716 COO C,3(.e
VALUATION $ LSQ FT
APPLICANT'S SIGNATURE 7-57__�,/'.5DATE z
IL aly- ONLY_
DEPARTWNT I)I�TRBUTICIN CITY OF MENIFEE BUSIN S LI ENSEIMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE -) � PAIDAMOUNT C CASH 0 CHECK#
AMOUNT 155;kLoL
CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT
I r' CASH 0 CHECK# CREDIT CARD VISAIIAC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER C' YES 0 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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