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PMT16-03522 City of Menifee Permit No.: PMT16-03522 29714 HAUN RD. Type: Residential Mechanical <A—CCELA—> MENIFEE.CA 92586 MENIFEE Date Issued: 10/2812016 P E R M I T Site Address: 27187 POTOMAC DR, MENIFEE, CA Parcel Number: 336-190-010 92586 Construction Cost: $17,552.00 Existing Use: Proposed Use: Description of 1 2.5 TON COMPLETE SPLIT SYSTEM&1 3TON COIL CONDENSER ONLY WITH DUCT WORK Work: (HVAC) Omer Contractor STEVE WILLIAMS A R S AMERICAN RESIDENTIAL SERVICES OF 27187 POTOMAC DR CALIFORNIA INC MENIFEE,CA 92586 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 Piz 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 builiding operations being carried on thereunder when in violation of the Building Code or of any other ordinance of City of Menifee.Except as othenAfise 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 forlefted- AA BidgPermit—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 aMrm 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 ci 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 Class e-10 C20 ("ele No By mysignature below I acknowledge that exceptfor my personal residence X72 f ExplresL�� tue,' in which I must have resided for at least one year priorto completion o / /V_ improvements covered by this permit.I cannot legally sell a structure that I ECLAILATIZIN 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 folloviiing 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 this permit is issued. www.leginfe.ca.gay/calaw.htmi. Policy# Date )pih,avc 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 certify to each of the following:I am the property this permit is issued.My worker's compensation insurance mriller and policy owner or authorized to act on the property owner's behalf.I have read this number are: applimbon and the information I have pmvided is correct.I agree to comply Carrier with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Pollcy#JUL S-061crsielq Expires (a 1--co In 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 wo,l,er's compensatil . . fS t' 3700 fth Labor rov o ec ion o e _�RKER'S COMPENSATION OV Code,I shall I om Wil 7 Will the applicant orfuture building occupant handlehazarclous material or a P mixture containing a hazardous material equal to or greater that the Ap.. n 16 -e IL- -I amounts specified on the Hazardous Materials Information Guide? WARNI ZFAILURETOSECU ERA E IS ci Yes A. UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of th e building by the applicant or future building AND CIVIL 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,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District SCAQMD)?See permitting checklist forguld I' CONSTRUCTION LENDING AGENCY 0 Yes 71 1 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 vib_ OWNER BUILDER DECLARATIONS I have mad the Hazardous Material Information Guide and the 5CAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of Contractor's License Law for the reason(s)indicated below by the California Heat h.&Sea �ocle, on 25505 a 25534 concerning checkmark(s)I have placed next to the applicable item(s)(Section 7031. hip"T ow t ru� Date Business and Professions Code).Any city or county that requires a permit to construct,alter,improve,demolish or repair any structure,prior to its TV n Issuance,also requires the applicant for the permitto file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRPJ 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 residence or childcare facility to be RRP-certified firms and comply with a n Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners a nd property than($500). managers who do the paint-disturbing work themselves or through their c 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.epa.goyllead or contact the National Lead Information Center at not Intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(532.3). 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 improves the property provided that the improvements a re 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 sa le. a No EPA Lead-Safe Certified Firm is required for this project because: a 1,as owner of the property a in 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. Ci'y O'=t1fee Ru'Idino 8, Y Dent. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION ��`Menlfee Received DATE 10 PERMIT/PLAN CHECK NUMBER 1)ffr I(# - 013S 2 2 TYPE: 0 COMMERCIAL Qr-RESIDENTIAL 0 MULTI-FAMILY - MOBILE HOME () POOL/SPA 0 SIGN SUBTYPE: 0 ADDITION 01 ALTERATION 1)DEMOLITION 0 ELECTRICAL �>VECHANICAL I I ONEW CIPLUMBING 0 RE-ROOF-NUMBER OF SQUARES I DESCRIPTION OF WORK To,---. 00�W(2�Ck_R A AAG Con, N 0 c>,-% V PROJECTADDRESS 2_1 5-1 ASSESSOR'S PARCEL NUMBER JCJ 0 -0 C)10 LOT TRACT OWNER NAME ADDRESS PHONE (o-1 CII EMAIL APPLICANTNAME ADDRESS PHONE EMAIL CONTRACTOR'S NAME OWNER BUILDER? 0 YES DWQ- BUSINESS NAME 0S15' ADDRESS PHONE e0o Luc EMAIL CONTRACTOR'S STATE LIC NUMBER -7(.aS_0 -7 c/ LICENSE CLASSIFICATION CIO C20 C,3Ce VALUATION$ ) 7, SO FT ��7 L SO FT APPLICANT'S SIGNATURE /I/DATE /0 Zze) Z/C,— DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GJEN SMIP ris 6 oq� INVOICE t 3-2,(. 10� PAIDAMOUNT OCASH CCHECK# AMOUNT 1 11 11 ,CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT 0 CREDIT CARD VISA/MC I I I �CASH "CHECKH 11 OWNER BUILDER VERIFIED 0 YES 0 No CLNUMBER NOTARIZED LETTER Q YES 0 NO City of Menifee Building&Safety Department 29714 Haun Rd. 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