PMT16-04030 City of Menifee Permit No.: PMT16-04030
29714 HAUN RD. Type: Residential Mechanical
-�ACCELA—> MENIFEE, CA 92586
MENIFEE Date Issued: 1210912016
P E R M I T
Site Address: 29727 COOL MEADOW DR, MENIFEE, Parcel Number: 339-392-003
CA 92584 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of 4 TON COMPLETE SPLIT SYSTEM
Work:
Owner Contractor
CINDY GEIBEL A R S AMERICAN RESIDENTIAL SERVICES OF
29727 COOL MEADOW DR CALIFORNIA INC
MENIFEE, CA 92584 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9512769744
CHRISTINA CALHOUN License Number:765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNU
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Qtv Amount
Forced-Air or Gravity-Type Furnace or Sumer 1 149.00
Air HandfinglCondensing 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 canied 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.Sldg_Perrni1_Template.rpt Page 1 of I
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 a I am exempt from licensum under the Contractor's State License Law for
Professions Code and my license is in full form and effect. the following reason:
Licerise Class CIO ezo -.116 en By my signature below I acknowledge that,except for my Personal residence
Expires Signatu in which I must have resided for at least one year priorto completion of
improvements covered by this permit.I cannot legally RIl a structure that I
WOR E S CQMPF 19 .7 'DECLA ION have built as a n owner-builder if It has not been constructed in Its entirety by
o I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applica life 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.leRinfo.ca.goy/calavv.huml.
Policy# Date
a 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 o 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 a re: ' application and the information I have provided is correct.I agree to comply
Carrier Lx with all applicable city and county ordinances and state laws relatingto
building construction.I authorize representatives ofthis city orcounty to
pollcyn 14,51'�T 1)9LP.'&L0 mplres 7 enter the above identified property for inspection purposes.
(This section need not to be completed Is the permit is I for one I hundred
r
]ON
dollars($100)or less Date
PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
I shall not ern Ploy any persons in any manner so as to become subject to the CITY BUSINESS LICENSE If M5007
worker's co,mpensistion laws of California,and agree that If I should become HAZARDOUS MATERIAL DECLARATION
'e &
ct to th wo it
subje,Aer's compens pr ion ofSe 700 of the Labor
I I f I 'mp h e Will the applicant or future building occupant handle hamrdous material or a
Code,I shall I m
A A plicant mixture containing a hazardous material equal to or greater that the
pplicant e ate amounts specified on the Hazardous Materials Information Guide?
W 4 e
ARM G:F T SECUREWORKFR'SCOMPENSAT a Yes 6-No
AND S14ALL SUBJECT AN EMI
UNIA 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
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or mod1flaition from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District ISCAQMD)?See pemitting checklist
forguldeflnes
CONSTRUCTION LENDING AGENCY 0 Yes Ck.
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 n.-'Wd-
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safe e,S in 2S505 34 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031 haz ilo s Ire
Business and Professions Code).Any city or county that requires a perrr;"'to I;7Dat. jDA'11'10
construct,alter,improve,demolish or repair any structure,prior to its V115,
PROP NER OW-Aut�
issuance,also requires the applicant for the permit to file a signed statement =W�N-r---
that he or she Is licensed pursuant to the provisions of the Contractor's State REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing whin 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
and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint in a pre-1978
an Applicant for a permit subjects the applicant to a civil pena Ity of not more residence or childcare facility to be RAP-certiffied firms and comply with
than($503). required practices.This Includes rental property owners and property
managers who do the paint-disturbinS 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 wwvi.epa-govIlead or contact the National Lead Information Center at
not intended or offered for safe.(Section 7044,Business a nd Professions 1-800-424-LEAD(S323).
Code,The Contractor's State License Law does not apply to an owner of a ci 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:
sa le.If,however,the building or Improvement is sold within one Yea r 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 Certiffled Firm is required for this project because:
a 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 ru le please fili out the RR P
Acknowledgement
B ILDING
U & SAFETY PERMIT/PLAN CHECK APPLICATION
',"I"'I'Menifee
DATE iiWo l(fi PERMIT/PLAN CHECK NUM=BER Wdt(D' 040
TYPE: 0 COMMERCIAL A�,RESIDENTIAL 0_ MULTI-FAMILY 0 MOBILE HOME _- POOL/SPA 0 SIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL 00%AECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 'A�TOr% —zA464,g.8nn
PROJECTADDRESS Cool VL^A�OLA�D "0'r.
9�U— 401D�LOT
ASSESSOR'S PARCEL NUMBER TRACT AS
OWNERNAME
ADDRESS
PHONE (5S t EMAIL
_)
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNERENUILDER? 0 YES ZKG—
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION CIO C-20 C15(p
VALUATION$ JC) occ S T L SO,FT
I APPUCP
CITY STAFF USE ONLY
DEPARTMEITF DISTRIBUTION
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE I ,
AMOU T tl;�4.10 PAID AMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0 CREDIT CARD VISA/MC
��CASH OCHECK#
OWNER BUILDER VERIFIED OYESO NO DL NUMBER NOTARIZED LEITER 0 YES 0 NO
City of Menifee Building& Safety Department 29714 HGUn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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