PMT16-03674 City of Menifee Permit No., PMT16-03674
29714 HAUN RD. Type: Residential Mechanical
<A-CCI=-LX--> MENIFEE, CA 92586
W.- MENIFEE Date Issued: 11114/2016
P E R M I T
Site Address: 26520 DAWSON RD, MENIFEE, CA Parcel Number: 331-170-017
92585 Construction Cost: $15,W4.00
Existing Use: Proposed Use:
Description of INSTALL 4 TON HEAT PUMP AIR HANDLER COMPLETE SPLIT SYSTEM
Work:
Owner Contractor
JAN FRENCH A R S AMERICAN RESIDENTIAL SERVICES OF
26520 DAWSON RD CALIFORNIA INC
MENIFEE,CA 92565 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9512769744
License Number:765074
Fee Description DIV Amount(S)
Forced-Air or Gravity-Type Furnace or Bumer 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 buillding 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.Bldg_Pe"it-Ternplate.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contnicts 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).
Chapterg(commeneing with section 7000)of Division 3 of the Business and o I am exempt from ficensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class CID C-20 C3 Upease . �yo'38 By my signature below I acknowledge that,except for MY personal residence
Expires Signature6 ZZ /t�l in which I must haw resided for at least one year prior to completion of
Improvements covered by this permit.I cannot legally sell a structure that I
WORKEWS COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
ci 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 website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.leginfo.m.goy/calaw.htnil.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
a I have and will maintain worker's compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which ci 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
Carrier wilth all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy It JtA 11 6PJ(V�b J 01'4Explres 1 Q 1-1 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit Ar one hundred Date
dollars($10D)or less PROPERTY OWNER OR AUTHORIZED AGENT
n I certify that in the performance of the work for which this permit is issued,
Ishallnotempi 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 workees compe ition pjavl;ions 9f Section 3700 of the Labor
wit
Code,I shall i h co 5h Will the applicant or future building occupant handle hazardous material or a
Applicant mixture containing a hazardous material eq ual to or greater that the
ov pecified on the Hazardous Materials Information Guide?
=Date '9/ -4 Lo amounts s
WARN14.�AILU�ETO SE2&AV15RRER'S COMPENSATION COVERAGE 15 0 Yes 01W
UNLAWFUL,AND SHALL SUBJECTAN 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 ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY a Yes D%
I hereby affirm that under the pena Ity of perjury there Ise 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 0410
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements underthe State of
I hereby affirm under penalty of perjuryttrat I am exempt from the California Health&SafetvCode,Sec Win 25505 25534 concerning
Contractoes License Law for the reason(s)indicated below by the bazajdpus Wtenal re g.
checkmark(s)I have placed nextbo the applicable item(s)(Section7031.5 r
Business and Professions Code).Any city or county that requires a permit to JIA'4 0�7
7T�� Date
construct,alter,improve,demolish or repair any structure,prior to its tPK1V-0WJNER OR AbTITORIZED AGENT
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,REPAIR AND PAINTING JRRPJ
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-certirted firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This Includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
ci 1,as owner of the property,or my employee with wages as their sole employees.For more information a bout EPA's Renovation Program visit:
compensation,Will do I 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 ri 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. ci No EPA Lead-Safe Certified Firm Is required for this pr*ct bemuse:
ci 1,as owner of the property am exclusively contracting With licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractoes state Ulcense Law does not apply to an owner of a If you r project does n ot comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
"Wenfee
.d�mkfth�_
DATE PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL IDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME POOL/SPA CSIGN
SUBTYPE: 0 ADDITION '_'ALTERATION 0 DEMOLITION 0 ELECTRICAL >44ECHANICAL
ONEW OPLUMBING () RE-ROOF-NUMBEROF SQUARES
DESCRIPTION OF WORK e� V/9��
PROJICTADDRESS
ASSESSOR'S PARCEL NUMBER 0*(>I�4- LOT TRACT
OWNERNAME V(-e_Y\C�1 __S(,y-,
ADDRESS 4&aV111e—
PHONE ('j 09) 11:1 — q�3-7 EMAIL
APPLICANT NAME y- VUI,- Ov--�
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNERBUILDER? OYESt�W
BUSINESSINIAME �&
ADDRESS :SC -5�,
PHONE 800 U(00 0(�oj�;_ EMAIL
CONTRACTOR'S STATE LIC NUMBER -7 LPS-0 7 L/ LICENSE CLASSIFICATION C/O CZ(.) C �%o
VALUATION $ L SO FT
1 APPLICANT'S SIGNATURE Z�L—L,,Z� DATE
CITYSTAFFUSE ONLY
DEPARTMENT DISTRIBUTION MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT 3zq - 10 � I � 0 CASH 0 CHECK# CREDIT CARD VtSA/MC
PAIDAMOUNT 0
PLAN CHECK FEES I I 1 0 CASH ",CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0 YES - NO OIL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586951-672-61-77
www.cityofmenifee.us Inspection Request Line 951-246-6213
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