PMT16-03966 City of Menifee Permit No.: PMT16-03966
29714 HAUN RD. Type: Residential Mechanical
";kCCELA> MENIFEE, CA 92586
V.- MENIFEE Date Issued: 1210512016
P E R M I T
Site Address: 26216 UNITAS CT, MENIFEE, CA 92585 Parcel Number., 331442-015
Construction Cost: $15,999.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT 4 TON COMPLETE SPLIT SYSTEM, FAU IN ATTIC 80,000 BTU
Work:
Omer Contractor
ROBIN REFIN A R S AMERICAN RESIDENTIAL SERVICES OF
26216 UNITAS CT CALIFORNIA INC
MENIFEE, CA 92585 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9512769744
KENNY PEERY License Number: 765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNU
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Oty Amount($1
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 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_Pemit—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 affirm under penalty of perjury that I am under provisions of wifth a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing wlith section 7000)of Division 3 of the Business and ot 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:
Licensecles,C10 C;rZ143�- License No.7 5 7e4
- J .2 By my signature below I acknowledge that,except for my personal residence
Expires_ �51-A:qIgnature p-44-14 aia A Awv�� in which I must have resided for at least one year prior to completion of
I F)— improvements covered by this permit.I cannot legally sell a structu re that I
WORKER'S COMPENSATION DECLARATION 0 have built as an owner-builder if it has not been constructed in its entirety by
,01 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 Relatlons 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. w%vw.Ieginfo.ca.flov/caIaw.htmI
Policy 4 Date
PROPERTY OWNER OR AUTHORIZED AGENT
� .4.have and will maintain worker's compensation Insurance,as required by
sectlon 3700 of the Labor Code,for the performance of the work for which cr 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 poricy 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
with 211 applicable City and county ordinances and state laws relating to
Cartier L—rl building construction.I authorize representatives of this city or county to
Policy# Exp-ires—/� — '%Q enter the above identified property for inspection purposes.
(This section need not to be col�leted 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# Sc)7
worker's compensation laws of California,and agree that if I should become RDOUS MATER
subject to the workees compensation provisions ofSection 3700 of the Labor
Code,I shall forthw'h comply w"Ith t ose provisions. ill the applicant or future building occupant handle hazardous material or a
Applicant :?e &A Date/0 mixture containing a hazardous material equal to or greater that the
� V- amounts specified on the Hazardous Materials Information Guide?
MLARNI NG-FAILURE TO SgCRE WORKWS COMPENSATION COVERAGE 15 ClYeS '121-111-0
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use cil'the bOi ding by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 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 pennitting ihecklist
IN SECTION 3706 OF THE LABOR CODE,INTER155G AN D ATTOANEYS FEES forguidelines;
CONSTRUCTION LENDING AGENCY oYes 5No
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) a Yes oyd"
OWNER BUILDER DECLARATIONS I have mad the Hazardous Material Information Guide and the SCAQMD
permitting checklisL I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)Indimted below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 E3Y ciNo X
F � 16
Business and Professions Code).Any city or county that requires a permit to eP Add:2V A&A44 Date—IgQ
construct,alter,Improve,demolish or repair any structure,prior to its PROPERTY OWNER OReVFIONRTIZEDZ�
issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the proviislions of the Contractor's State EPA RENOVATION,REPAIR AND I RI
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 licensum receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Sectkul 7031.5 by residence or childimm facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penaltVof not more required practices.This includes rental property owners and property
than($500). managers who do the paint-clisturbing work themselves or through their
ct 1,as owner of the property,or my employee With wages as their sole employees.For mom information about EPA!s Renovation Program Visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epamovAmcl 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`5 State License Law does not apply to an owner of a ct An EPA Lead-safe Certified Renovator Will be responsible for this project
property who,through employeeV 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. 0 No EPA Lead-Safe Certified Firm is required for this project bemuse:
E3 1,as owner of the property am exclusively contracting with licensed
contractors to construct th a project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a Ifyour project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
,.g"Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL ��SIIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION OALTERATION OIDEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 2—/ 6'6?1Le CIC-7e IjT IS V3T�iq
F-14a IA ; Amt. �!D
PROJECTADDRESS CT 1v1u&l1 F-c-E: cl�- q_R,,S&S
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME ec"4>1'A ) R uf
ADDRESS
PHONCZ0 EMAIL
APPLICANT NAME //u 4
C -k2
ADDRESS
PHONE lio)Z264-66- 7—S EMAIL
CONTRACTOR'S NAME !j-A Fl-�;IvE- OWNER BUILDER? 0 YES 0 NO
BUSINESS NAME
ADDRESS 163L) vf gs Ilk (7,�7_a-,
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER76 56 7,�l LICENSE CLASSIFICATIOWJ'� C 2�� C 3f r,
VALUATION$ �q _ SQ FT L SO FT
APPLICANIT'S SIGNATURE DATE
CITYSTAFF USEONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEEHUSINUSLILLINISLNUMBEK
BUILDING PLANNING ENGINEERING FIRE GREEN � too SMIP I I
INVOICE DAMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
AMOUNT -to PA' I
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 No DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building& Sofety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofrnenifee.us Inspection Request Line 951-246-6213
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