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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. 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