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
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