PMT16-04256 City of Menifee Permit No. PMT16-04256
29714 HAUN RD. Type: Residential Mechanical
<A-CC1ElL]A—> MENIFEE, CA 92586
MENIFEE Date Issued 12/2012016
P E R M I T
Site Address: 25738 RIDGEMOOR RD, MENIFEE, CA Parcel Number: 339-152-014
92586 Construction Cost: $21,782.00
Existing Use: Proposed Use:
Description of 4 TON COMPLETE SPLIT SYSTEM WTH DUCT WORK REPLACEMENT
Work:
Owner Contractor
MARCELLO ONTIVERO A R S AMERICAN RESIDENTIAL SERVICES OF
25738 RIDGEMOOR RD CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9512769744
CHRISTINA CALHOUN License Number:765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORND
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS,CA 38120
Fee Description Qtv Amount I$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 building 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.8ldg_Penik_TempIate.rpt Page 1 of I
CITY OF MENIFEE
LiaNSED 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 contractar(s)pursuant to the Contractors State License Law).
Chapterg(commencing with section 7000)of Division 3 of the Business and a I am exempt tram hoensure under the Contractor's State License Law for
Professions Code a nd my license is in full force and effect. the following reason:
UcenseClass- "W"', C.*4 By my signature below I acknowledge that,except for my personal residence
Expires Zfsign lure in which I must have resided far at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
MPENSATION DECLARZTW<IC'� have built as an owner-builder if it has not been constructed in its entirety by
a 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 wIf-insure for workees 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.legin lo-ca.gay/calaw.h1ml.
Policy Date
PROPERTY OWNER OR AUTHORIZED AGENT
o I haw and will maintain workees compensation Insurance,as required by
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 fallowing: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 behalE I have read this
numberare: , application and the information I have provided is correct I agree to comply
Carrier LJ6V4q withaR applicable city and county ordinances and state laws relating to
0 building constnuction-I authorize representatives of this city or county to
P-iicv# enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for cme-hundred Date
delta"($100)or less PROPERTY OWNER OR AUTHORIZED AG ENT
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# o;550'7L(
worker's compensation laws of California,and agree that if I should became HAZARDOUS MATERIAL DECLARAT10N
subject to the worker's compen g,'nprov'I of Sect 3700 of the Labor
s,0 er
Code,I shall fc: tho r ons Will the applicant or future building occupant handle hazardous material or a
le Aff/,/'I— mixture containing a hazardous material equal to or greater that the
Applicant ate amounts specified on the Hazardous Materials Information Guide?
—�TO SELYRE kO Z
0 MPC S TIC
WARNINGL R'S COMPENSATION COVERAGE IS Dyes
UNLAWFUL,AND SHALL SUBJIELr AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVI L FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,00D),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(SCACIM D)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guld fi
CONSTRUCrION LENDING AGENCY ,Yes ;C
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modif"red facility be within 10DO feet of the
lending agency for the performance of the work which this permit is issued outer b d ofaschoul?
(Section 3097 Civil Code) 0 yes ox
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 Code, ion 2 ncerrung
Contractor's License Law for the reason(s)indicated below by the hazarStaul ma :repo �!��o
checkmark(s)I have placed next to the applicable items)(Section 7031. 0 �01
7r�pfl;-" , Da
Business and Professions Code),Any city or county that requires a permit to
construct,after,improve,demolish or repair any structure,prior to its kROPATMWINER OR ALITITOILIZEBIRGENT
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 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)or that he or she is exempt from ficensure 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 RRIP-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-clisturbing work themselves or through their
a 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPXS Renovation Program visit:
compensation,will do( )all of or( I portion of the work,and the structure is www.epa-goryllead or contact the National Lead Information Center at
not intended or offered for sale,(Section 7044,Business and Professions 1-800424-LEAD(5323).
Code;The Contractor's 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 employen'ar personal effort,budds or improves the
property provided that the improwments 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 far the purpose of sale. u No EPA Lead-Safe Certified Furn 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 Contractoes State License Law don not apply to an owner of a If your project does not comply with EPA RRP rule please rill out the RRP
Acknowledgement
& SAFETY PERMIT/PLAN CHECK APPLICATION
DATE Z. I zo PERMIT/PLAN CHECK NUMBER _PM1110- 04M(c
TYPE: COMMERCIAL 4?'RESIDENTIAL 0 MULTI-FAMILY C MOBILE HOME Cl POOL/SPA ''SIGN
SUBTYPE: CADDITION ��-ALTERATION ODEMOLITION -' ELECTRICAL XMECHANICAL
0 NEW PLUMBING RE-ROOF-NUMBER OF SQUARES—
DESCRIPTION OF WORK 4Ton i2bmiele4t -5fU4- -5j-sA<Ae-% 1,4�w+tt
PROJECTADDRESS ZS-1*6PS JZ
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNERNAME tnV%Vjtrf) jV\",r"0
ADDRESS g,,-b
PHONE (J'01N -Ztb— _111tp EMAIL
APPLICANTNAME Mir-45vtv"IN— 0—"6 vv_l
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? YES 0NO
ADDRESS
PHONE (,jaC) 540-11j EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION 1210 CZ6 Ci(v
VALUATION$ ,-'7 L SO FT
APPLICANT'S SIGNATURE DATE 12 A6 A.
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE I !�� PAID AMOUNT
AMOUNT I 1 0 CASH 0 CHECK N CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT
I 1 0 CASH CHECK 4 _—CREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0' YES U NO
Cit,V 01 114F.'llifee 6(illdifIg& 5(JjPtV 0eportment 29 714 Haun Rd. Nlenifee, CA 92586 951-6 72-6771
ivv,,w.,itvoftnemlee-fis /nspef tion RequestLine 1351 246-6213
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