PMT17-01624 City of Menifee Permit No.: PMT17-01624
_ 29714 HAUN RD. Type: Residential Mechanical
'ACCEll MENIFEE,CA 92586
MENIFEE Date Issued: 0 512 3/2 01 7
PERMIT
Site Address: 26447 LAZY CREEK RD,MENIFEE, CA Parcel Number: 338-120-003
92586 Construction Cost: $15,215.00
Existing Use: Proposed Use:
Description of REPLACE HVAC, 3-TON A/C,80,000 BTU FURNACE WITH DUCTING
Work:
Owner Contractor
CHRISTIAN ARSCOTT A-AVIS PLUMBING HEATING&AIR CONDITIONING
26447 LAZY CREEK ROAD INC
MENIFEE,CA 92586 600 EAST VALLEY BLVD
Applicant Phone:9098253600
MITCH BLUMAN License Number:630503
A-AVIS PLUMBING HEATING&AIR CONDITIONING INC
600 EAST VALLEY BLVD
COLTON, CA 92324
Fee Description OQt Amount($)
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 Pernit_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 o I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect, the following reason:
License Class (03 050 3 License 20,G 3
By my signature below I acknowledge that,except for my personal residence
Expires 31 (� 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 DECLARATION have built as an 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 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 www.legmfo.ca.Rov/caIaw.htmL permit is Issued.
Policy N Date
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 ❑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 �j}a.�e 1ruvtl6 with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy p 1�i (� Expires FJ 17 enter the above Identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑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 g
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers comp sation provisions of Section 3700 of the Labor
Code,I shall forth it c with thos provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date 3 (7 mixture containing a hazardous material equal to or greater that the
amounts sp9e�cified an the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes dNo
UNLAWFUL,AND SHALLSUBIECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building hythe 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 guidelln}}s
CONSTRUCTION LENDING AGENCY Dyes dNo
I hereby affirm that under the penalty of perjury there is a construction WIII 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 bourydary of a school?
(Section 3097 Civil Code) ❑Yes No
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
Contractors License Law for the reason(s)indicated below by the hazaCalifornia Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed nextto the applicable item(s)(Section 7031.5 oYes oAmaterifa�lfJ�e/jpJ/ing. --I
Business and Professions Code).Any city or county that requires a permitto oyes IQo'I/c ;f �,3 ( /
construct,alter,improve,demolish or repair any structure,prior to its P+ERTY Date
Issuance,also requires the applicant for the permitto file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
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 or through their
❑I,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( I all of or( )portion of the work,and the structure is www.eua.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-900-424-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 ofthe 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 Ifyour project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
E
&enifee
DATE 23 I PERMIT/PLAN CHECK NUMBER v e
TYPE: ❑COMMERCIAL RESIDENTIAL MULTI-FAMILY EIMOBILE HOME POOL/SPA SIGN
SUBTYPE: [:]ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL 161VIECHANICAL
❑NEW ❑PLUMBING [:IRE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK P420010a k IC 3 }on eei r✓
i1 '1 L'0 dAC4 id ,
I U City of Menifee
PROJECTADDRESS 2� I l �Z' Cr gkc - Qo�;JO�L[ Building
d & Safety Der L
ASSESSOR'S PARCEL NUMBER p 3�• 100 - �p?j LOT TRACT > 2
PROPERTY
�7OWNER'S NAME (�', T0.n + '4-
ADDRESS I11 L�� Rd • (@CG- IV
PHONE 4]ri1 - p 121 {� EMAIL
`v APPLICANT NAME "-� 1^ `91
ADDRESS 3k )-*2S 1-0. �- �r. ' 2`3 We5i.1„1oe. t 0-2
PHONE `jam-73rD - 1`b�S� EMAIL 44
CONTRAii NAME
n !1 - f�1jjUi LtMb' OCA4' - r'' ( OWNER BUILDER? ❑YESmNO
BUSINESS NAME C1' PV'S 7 �u"eE� Q&�,*t A;r
ADDRESS Vow Q ni D(u d' -
PHONE 409 -`3'2-5 - 3(00a EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION C,20 L 3
VALUATION $ 1.t) `Z 15 SO FT LSQ FT
APPLICANT'S SIGNATURE DATE 23 •!�
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP u
INVOICE •1b PAID AMOUNT f, �.,
AMOUNT :J�`-1 •,d CASH CHECK# %CREDITCARD VISVMC
PLAN CHECK FEES PAID AMOUNT CASH v}CHECK# CREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0YES C% NO DL NUMBER NOTARIZED LETTER C:' YES ':% NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityafinenifee.us Inspection Request Line 951-246-6213
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OURFAMILYi OE FOR JGENE TCN ' BO�h'Dept,
MAY 13 2017
Akt
--
PLON91NGlNEATNIGIA/RCONDITIONING,INC. eC@fyed
600 E.V.W.EY BL M.CIXT CA 92324
CITY AND COUNTY BUILDING DEPARTMENTS
I hereby authorize the following persons from Wermit ERaters(see attached page for complete list)to
act on my behalf in obtaining business licenses and permits from the Building and Safety Department,
and to sign for permit and related applications on my behalf. I am properly licensed as required by
the State of California.
I assume full responsibility under the law for permits taken out by persons authorized to act on my
behalf.
This authorization shall continue until the Department of Building and Safety of each City and County
is notified in writing that such authorization has been canceled.
COMPANY NAME:A-Avis Plumbing-Heating&Air Conditioning, Inc.
License Number 630503 C-20,C-36
BY:James Ed Ballard
TITLE: Presid�2&zl
ennt SIGNATURE: •�'r''L DATE:
PERSONS AUTHORIZED TO SIGN AND OBTAIN PERMITS:
ERIC JACOBY
IAN JACOBY
JENNIFERJACOBY
ALLENJACOBY
MYRNA IBARRA
BEN MEDINA
STEVE SCHNIERER -
MAXINE BROOKS --- - _ -
TIFFANY DOUTHIT
ROBERT MILLER -- -----
ROBERT GORMAN
ANAMARIE ROMO -
DREW QUEEN
HOWARD VANLANDINGHAM
MICHAEL 1BARRA
APRIL RODRIQUES
MITCH BLUMAN - �^
CALLENJOHNSON
NICHOLAS MEDINA
MEIRAV EISENBERG
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ I789
v`-.�_.^�z.�.-ndr•N.Nmocrxr-r�..�^:i•'.�,r.=.�Ys2i._ a.. <-.�„c _ - - z.- ra,- - n,
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that,
State of California )
County of LD 5 th Q 1 C S )
On before me, P)r 'I4A tease r o ru p Lwc,
Date p- -r!-Iere Inked,Name and Title of the fficer
personally appeared JQrn e 5 —U BQ 11 (2 rcC
Name(s)of Signer(s)
who proved to me on the basis of satisfactory evidence to be the personiO whose name(, &are
s bscribed to the .within instrument and acknow ged to me tha she/they executed the same in
is er/their authorized capacity(iA and that b iS er/their signature(g)on the instrument the persorm,
or the entity upon behalf of which the personfol�, executed the instrument.
I certify under PENALTY OF PERJURY under the laws
vEps n5�4 ay of the State of California that the foregoing paragraph
ZN6 Z;2tia is true and correct-
v
t,a m poe' colvP� 20�9 WITNESS my hand and official seal.
�S3 ;.o�a�y pn9eless Puog2.
�: mR pomm' Signature
, :•:,sr My
Signature o otary Public
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description ttached Document
Title or Type of Do nt: Document Date:
Number of Pages: _ ner(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: Signer's Name:
Corporate Officer — Titie(s): Corporate Officer — Titie(s):
i Partner — Limited General ner— Limited '. General
Individual Attorney in Fact i !Indivi Attorney in Fact
Trustee Guardian or Conservator Trustee Guardian or Conservator
Other: Other: _
Signer Is Representing: Signer Is Representing:
02014 National Notary Association• www.NaUonaiNotary.org•1-800-US NOTARY(1-800-876-6827) Item 07