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PMT16-03529 City of Menifee Permit No., PMT1 6-03529 <— 29714 HAUN RD. Type: Residential Mechanical A CELA- MENIFEE. CA 92586 MENIFEE Date Issued: 10/31/2016 P E R M I T SiteAddress: 28281 VIA CASCADITA, MENIFEE, CA Parcel Number: 336-322-021 92585 Construction Cost: $5,000.00 Existing Use: Proposed Use: Description of 2.5 TON FURNACE ONLY 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 CHRISTINA CALHOUN License Number: 765074 A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIi 965 RIDGE LAKE BLVD SUITE 201 MEMPHIS, CA 38120 Fee Description ON Amount Forced-Air or Gravity-Type Furnace or Bumer 1 149.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Mechanical 1 7.45 $184.45 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 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_Pennit-Ternplaterpt 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 E3 I am exempt from licensure under the Contractoes State License Law for Professions Code and my license is in full force and effect. the following reason: License Class 0 20 Lic No.-1 t-o'%bT41 By my signatu e below I acknowledge that,except for my personal residence in which I must have resided for at least one year priorto completion of Expires Sip na ure 01 improvements covered by this permit.I cannot legally sell a structure that I R'SCOIVIPENSMATIONDECLARAQ�L*' (-1�� s 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 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 webske: by Section 3700 of the Labor Code,for the performance of work for which this permit is issued. www.leRinfo.ca.gov/caIaw.htmL Policy# Date ci 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 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 on the property owner's behalf.I have read this number are: application and the information I have provided is correct.I agree to comply with all applicable city and county ordinances and state laws relating to Carrier L I V06y,�,q building construction.I authorize representatives of this city or county to Policy#1(,b5D Sto-6101q Expires itahb 11-1 enter the above identified property for inspection purposes. 1 0 (This section need not to be completed is the permit is for one-hundned Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT ci I certify that in the performance of the work for which this permit Is issued, ishallnotemp] any persons in any manner so as to become subject to the CITY BUSINESS UCENSE# worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the worker's compe tionercililsions of Section 3700 of the Labor Code,I shall f�f ith rovi " Zi com Will the applicant or future building occupant handle hazardous material or a mixture containing a hazardous material equal to or greater that the 'fled on the Hazardous Materials Information Guide? Applicant:7) 4!2v 'Date_ amount5sp ci WARNIN�if6AI(W�RE TO SE�CU"-O�RKER'S COMPENSATION Z COVELGE Is u Yes UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building 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 permitting checklist IN SECTiON 3706 OF THE LABOR CODE,INTEREST,AND ATrORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY ciYes 13-4to- 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) o Yes 0>0 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&Safeptpde,5 n 25505 an 25534 concerning b Contractor's License Law for the reason(s)indicated below by the haz s �teri`lll checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 1 ":Aring. Businessand Professions Code).Any city or county that requires a permit to r Date e1613 W!� I/Al construct,alter,improve,demolish or repair any structure,prior to its LPRQPfiiWOWNER OR AUTHORIZED Ad—ENT 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 Contractor's State EPA RENOVATION,REPAI R AND PAINTING IRRPI 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 FIRP-certified firms and comply with an Applica nt for a permit subjects the applicant to a civil pane Ity of not more required practices.This includes renta I property owners and property than($500). managers who do the paint-disturbing Work themselves or through their o 1,as owner of the p roperty,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit: compensation,will do I )all of or( )portion of the work,and the structure is www.eria.eavAead 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 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 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 project bemuse: ci 1,as owner of the property am exclusively contracting with licensed contractors to construct the project(Secrion 7D44,Business and Professions Code:The Contractor's State License Law does not apply to an owner of a If you r project does not comply with EPA RRP role please fill out the RRP Acknowledgement. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION A.- ,,-,,*,,- ,-Menifee DATE to PERMIT/PLAN CHECK NUMBER TYPE: COMMERCIAL 7?,*SIDENTIAL - MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA OSIGN SUBTYPE: �ADDITION C ALTERATION 0 DEMOLITION 0, ELECTRICAL �OMECHANICAL ONEW OPLUMBING 0 RE-ROOF-N UMBER OF SQUARES _Z. De-1 DESCRIPTION OF WORK 'T T PROJECTADDRESS Z87_4&j '\j I cA, (2-a-5 C_C.%.c�'N AC7C.., ASSESSOR'S PARCEL NUMBER W-914 0CM LOT (0(P TRACT 16�5Vb OWNER NAME V-\,x V,\.2 ADDRESS ��A v�_� PHONE(<'ff1_) (D_JC� - U_jf3L_o EMAIL APPLICANT NAME eaWw, ADDRESS 2_0� ktl,� PHONE EMAIL CONTRACTOR'S NAME OWNERBUILDER? OYES 9NO BUSINESS NAME ADDRESS ;�016C) PHONE boo Lo co 0 0(�p-i S-- EMAIL CONTRACTOR'S STATE LIC NUMBER (x -1 C4 LICENSE CLASSIFICATION C/o (_20 C VALUATION $ �S_IDO&z� Z�z L SO FT APPLICANT'S SIGNATURE DATE ,,9 , 7i (e DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER -BUILDING PLANNING 4NGINEERING FIRE GREEN SMIP INVOICE I wi.q� I AMOUNT PAIDAMOUNT CASH "CHECK# 0 CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES 0 No DL NUMBER NOTARIZED LETTER C YES 0 NO City of Menifee Building &Sofety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofnienifee.us Inspection Request Line 951-246-6213 ru k6 2 0 0 0 .2- i7i m C E 4! 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