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. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us inspection Request Line 951-246-6213
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