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PMT17-01472 City of Menifee Permit No.: PMT17-01472 29714 HAUN RD. <A-CCEL_A—> MENIFEE, CA 92586 Type: Residential Mechanical MENIFEE Date Issued: 05/09/2017 PERMIT Site Address: 27170 CAPILANO DR, MENIFEE, CA Parcel Number: 336-062-017 92586 Construction Cost: $18,578.00 Existing Use: Proposed Use: Description of INSTALL 4 TON COMPLETE SPLIT SYSTMEN HVAC- 17 SEARS Work: Owner Contractor . LAWRENCE POWELL A R S AMERICAN RESIDENTIAL SERVICES OF 27170 CAPILANO DRIVE CALIFORNIA INC MENIFEE,CA 92586 965 RIDGE LAKE BLVD SUITE 201 Applicant Phone:9512769744 A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORND License Number:765074 965 RIDGE LAKE BLVD SUITE 201 MEMPHIS, CA 38120 Phone:9512769744 Fee Description g,yt Amount fbl 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 $324.10 The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be forfeited. AA_Bldg_Permit_Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from[!censure under the Contractors State License Law for Professions Code and my license is in full force and effect. the following reason: License Class CIO C2o C$(p U s No By my signature below I acknowledge that,except for my personal residence Expires I Signature in which I must have resided for at least one year prior to completion of improvements covered by this permit.I cannot legally sell a structure that I WORKER'S COMPENSATION DEC have built as an owner-builder If it has not been constructed in its entirety by ❑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 self-insure for workers 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 coca,,�,,leeinfo.ca.epv/calaw.hunl. this permit is issued. Policy q Date s6i have and will maintain workers compensation insurance,as required 6y PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which a-By,my signature below I 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 owners behalf.I have read this number are: application and the information I have provided is correct.I agree to comply Carrier with all applicable city and county ordinances and state laws relating to build! construction.I hori re esentaf f this city or county to Policy# l(031 TOV5 110110 Expires 10 ( en r ea ve ide edp p for ins c' npurposes. (This section need not to be completed is the permit is for one-hundred Date 'S 7 dollars($100)or less pit OW A ED NT ❑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 N worker's compg'on laws of Calprnia,and agree that if I should became HAZARDOUS MATERIAL DECLARATION subject to thers compens ion pr insof i 3700 of the Labor Code,I shall oh co i th t s pr visio Will the applicant or future bu0ding occupant handle hazardous material or a v mixture containing a hazardous material equal to or greater that the Appllcan Date amounts specified on the Hazardous Materials Information Guide? WARN AILURE TO SECURE WORKER'S COMPENSATION COVE GE IS o Yes RINo UNLAWFUL,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 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 permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY ❑Yes ®No 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) ❑Yes PKflo OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the 5CAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of Callforn' Ith&Safety dZAGENT n 34 concerning Contractors License Law for the reason(s)indicated below by the hazar u ial rep checkmark(s)I have placed next to the applicable Rem(s)(Section 7031.5 Business and Professions Code).Any city or county that requires a permit to 5� 17 construct,alter,improve,demolish or repair any structure,prior to its NUN-ffate issuance,also requires the applicant for the permit to file a signed statement TY OWNER OR that he or she is licensed pursuant to the provisions of the Contractors 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 licensure 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 RRP-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-disturbing work themselves orthrough their ❑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 www.eva.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 Contractors State License Law does not apply to an owner of a ❑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: 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. ❑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 not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement. BUILDING & SAFETY PERMIT/PLANAPPLICATION Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: ❑COMMERCIAL RESIDENTIAL [-]MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN SUBTYPE: ❑ADDITION []ALTERATION ❑DEMOLITION []ELECTRICAL MECHANICAL ❑NE/IW F]PLUMBING ❑RE-ROOF-NUMBER OF SQUARES ttl DESCRIPTION OF WORK Ton COY1l S HAG 1-1 ayS I KD kgWM p7 ^ PROJECTADDRESS 2.1�1� l.rOl 110.Y►p <• �12 OIL ASSESSOR'S PARCEL NUMBER Lo 2-O I f LOT Cl)1 TRACT 73 0� PROPERTY OWN ER'SNAME � ADDRESS Z11 Q PHONE (l(oo) 4S'8- 151 60 'EMAIL APPLICANT NAME r,' y1 0vw—, ADDRESS 3030 MYERS ST RIVERSIDE CA 92503 PHONE (800)660-0675 EMAIL CONTRACTOR'S NAME RIGHTIME OWNER BUILDER? ❑YES©NO BUSINESS NAME ARS ADDRESS 3030 MYERS ST RIVERSIDE CA 92503 PHONE (800)660-0676 EMAIL CONTRACTOR'S STATE LIC NUMBER 765074 LICENSE CLASSIFICATION C10 C20 C36 VALUATION$ IS S�8 LSQFT e It APPLICANT'S SIGNATURE DATE T CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP INVOICE PAID AMOUNT AMOUNT OCASH 0CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO City of Nlenifee Building&Safety Department 29714 Haun Rd. 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