PMT16-03800 City of Menifee Permit No.: PMT16-03800
29714 HAUN RD.
<A-CCElijA—> MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 11128/2016
P E R M I T
Site Address: 31316 SHERMAN RD, MENIFEE, CA Parcel Number: 360-570-003
92584 Construction Cost: $6,458.00
Existing Use: Proposed Use:
Description of 5 TON FURNACE ONLY
Work:
Owner Contractor
DIANE KEEL A R S AMERICAN RESIDENTIAL SERVICES OF
31316 SHERMAN RD CALIFORNIA INC
MENIFEE,CA 925a4 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9512769744
CHRISTINA CALLHOUN License Number:765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNI)
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Qtv Amount
Forced-Air or Gravity-Type Furnace or Burner 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 pemit 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_B1dg_Permit—Temp1ate.rpt 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).
Chapter!)(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 Uc By my signature below I acknowledge that,except for my personal residence
at re in which I must have resided for at least one year prior to completion of
Expires improvements covered by this permit.I cannot legally sell a structure that I
- 17 Sig
�RS COOMPEENSATON DECLA have built as an owner-builder if it has nut been constructed in its entirety by
n 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-ca.gov/calaw.htmi.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
o 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 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
numberare: , application and the information I have provided is correct.I agree to comply
Carrier Li with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# -14 i6wip"5101V Expires AeAS 16 h-7 enter the above Identified property for Inspection purposes.
(This section need not to be completed is the permit!,
dollars($100)or less is for one-hundred PROPERTY OWNER OR AUTHORIZED AGENT Date
in 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# 015507Lf
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compen 0 prov- - of Sect- 3700 of the Labor
Code,I hall f tho r c.s Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant 7, ate 4 amounts specified on the Hazardous Materials Information Guide?
WARNING&Afi&I!fT�0SECI3'R'E 11(0jWAW�5COMPENSATION CdVERAG"E 15 0yes /No
UNLAWFUL,AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UPTO 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 for guld I"
CONSTRUCTION LENDING AGENCY 0 Yes ;�;
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 b d of a school?
(Section 3097 Civil Code) a Yes a9z
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&Safety Cod nd
Contractor's License Law for the reason(s)indicated below by the e,110513on 7oncerning
hazaroeM at '=repo
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 m
construct,alter,Improve,demolish or repair any structure,prior to its it to lu�a'
Business and Professions Code).Any city or county that requires a perm' �gD.e
issuance,also requires the applicant for the permitto file a signed statement kRQFIfkTMWNER OR ALWokuRTICGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR 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)orthat 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
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 about EPA�s Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eva.gov/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 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. ci No EPA Lead-Safe Certified Firm is required for this project because;
ci 1,as owner of the property am 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Men ifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: IIOCO�MERCIAL /-RESIDENTIAL OMULTI-FAMILY 0MOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL CK-MECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK S--T-br) 0-v�w,
PROJECTADDRESS 5%1016 �>"ryv�e�
ASSESSOR'S PARCEL NUMBER !�;UO GJ&J)O*P LOT TRACT
OWNERNAME
ADDRESS -61-5(C,
PHONE C-1-5-0 — EMAIL
APPLICANTNAME
ADDRESS
PHONE EMAIL
CONTRACTOIR'S NAME OWNERBUILDER? 0YESOP7*9
ADDRESS
PHONE Aon jg(go e)Ce -7 C;:-- EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION CIO C04 6360
VALUATION$
L SQ FT
APPLIC NVS SIGNATURFZ!�—
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION SMIP LIIYU�MLNI�LLBUbINILbbULLNSLNUMULK
BUILDING PLANNING ENGINEERING FIRE GREEN 160
INVOICE
AMOUNT PAID AMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
[O�WNER BUILDER VERIFIED 0 YES 0 No DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building& Sofety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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