PMT17-01180 City of Menifee Permit No.: PMT17-01180
29714 HAUN RD.
�A-CCELAI' MENIFEE,CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 0 411 9/2 01 7
PERMIT
Site Address: 28237 CORTE RETIRO,MENIFEE, CA Parcel Number: 336-272-024
92586 Construction Cost: $13,777.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING HVAC WITH 3 TON COMPLETE SPLIT SYSTEM FAU IN CLOSET 16 SEER
Work: 70,000 BTU FURNACE
Owner Contractor
MARIE JEFFRIES A R S AMERICAN RESIDENTIAL SERVICES OF
28237 CORTE RETIRO CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9512769744
MENIFEE,CA License Number:765074
Fee Description Qtv Amount($
Forced-Air or Gravity-Type Furnace or Sumer 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_Bldg_Pernit_Templatespt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
1 herebyaffirm under penalty of with a licensed contractor(s)pursuant to the Contractors State License Law).
P tY Perjury that under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and O I am exempt from licensure under the Contractors State License law for
ProFessions Code and my license is in full force and effe
ct. the following reason:
License Claw 42(0pG20/[3�Umnse No. By mysignature below l acknowledge that except for my personal residence
Expires�_�. N.M ignature in which lmust have resided for at least one year prior to completion of
improvements covered by this permit 1 cannot legally sell a structure that I
WORKERS COMPENSATION DECIARATION have built as an owner-builder if it has not been constructed in its entirety by
f,1 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 workers 7044 of the Business and ProFessions Code,is avalabie 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 vnnv.leeinfo.ca.=pv/calmv.html.
this permit is issued. -
Policy N Date
O I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which aBy my signature below l certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.l have read this
number are: application and the information 1 have provided is correct I agree to comply
Cartier "' with all applicable city and county ordinances and state laws relating to
Policyg7
i building construction.I authorize representatives of this city or county to
�SfJSL/U6 f(/ Expi 0. - , 7 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit or for one-hundred Date.
dollars($100)or less
PROPERTY OWNER OR AUTHORIZED AGENT �'7
O l certify that in the performance of the work for which this permit is issued, Q �5� 1
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE S
worker's compensation laws of California,and agree that If should become RDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forth- "th comply with those provisions. /Will the applicant or future building occupant handle hazardous material or
Applicant Date ire containing a hazardous material equal to or greaterthat the
�{' amounts specified on the Hazardous Materials Information Guide?
WARNING ' R FAILURE TO SEWORK S COMPENSATION COVERAGE LS - aYes J�
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended useof the building by the applicant or future building
AND CIVIL FINES UP TO 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(SCAOMD]?See permitting checklist
IN SECTION 370r OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES foastAirlines
Qua
CONSTRUCTION LENDING AGENCY aYes i o
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?
(Section3W7 Civil Cade) DYes D�
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that l am exempt from the permitting checklist l understand my requirements under the State of
Contractors License law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next tn the applice hazardous material reporting.
applicable item(s) 70315 oY oNo Jny /Business and Professions Code).Any city or county that requires a permit to �,QQ�yI Date
construcqalter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR F�ORILED
issuance,also requires the applicant for the permit to rile a signed statement L�
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRP)
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 licensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 70315 by Tesidence or childcare facility to be RRP-certified firths and comply with
an Applicant for a permit subjects the applicant to a civil penalWof not more fequired practices.This includes rental property owners and property
than($SOD). managers who do the paint-disturbing work themselves or through their
O1,as owner of the property,or my employee with wages as theirsole employees.For more information about EPAs Renovation Program visit
compensation,will do( )all of or( ]portion of the work,and the structure is wum.ena.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 notapply to an owner of a ❑An EPA Lead-Safe Certified Renovatorwiil be responsible forthis 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-Budderwil have the burden of proving that it was
not built or improved for the purpose of sale. D No EPA Lead-Safe Certified Firm is required for this project because:
O I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does notapply to an owner of a If your project does not comptywfth EPA RRP rule please fill out the RRP
Acknowledgement
pp
SAFETY PERMIT/PLAN CHECK APPLICATION
"Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: [:]COMMERCIAL , RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA []SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION []ELECTRICAL ElMECHANICAL
❑NE??W ❑PLUMBING ❑RE-ROOOF--N�UMBEEROOF�SQUARES
DESCRIPTION OFWORK
F41 /(I CfaSF/ 5r yz� 76
PROJECT ADDRESS ,
ASSESSOR'S PARCEL NUMBER 3�J(.O )-'72'02-4 LOT Ro TRACE �S
PROPERTY OWNER'S NAME �/T/J"� /LJ
ADDRESS ��yy1✓ J7'sIJGG�
PHONE 0-5() cl�pp' '7/N ` p�� EMAIL
APPLICANT NAME 'CJ 1� 1 W
ADDRESS 3030 MYERS ST RIVERSIDE CA 92503
PHONE (600)660-0675 EMAIL
CONTRACTOR'S NAME RIGHTIME OWNER BUILDER? ❑YES ✓❑NO
BUSINESS NAME ARS
ADDRESS 3030 MYERS ST RIVERSIDE CA 92503
PHONE (800)660-0675 EMAIL
CONTRACTOR'S STATE LIC NUMBER 765074 LICENSE CLASSIFICATION C10 C20 C36
VALUATION$ lam. 7 7 j SQ FT � 77 L SO FT / 1
APPLICANT'S SIGNATURE / l/,�l k& ' 4,0 DATE
DEPARTMENT DISTRIBUTION, CITY OF MENIIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP ?S60
-14
INVOICE PAID AMOUNT
AMOUNT OCASH 6CHECKA OCREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZEDLETTER O YES G NO
City of Menifee Building F Safety Deportment 29714 Haun Rd. Menifee, CA 92585 95bftj-'bfM6hIfee
www.cityofinenifee.us Inspection Request Line 951-246-6213 Building & Safety Dept.
APR 19 2017
e��ived
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