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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 °o 0 0 0 0 o T T D v D t� w w _ m x a z s M oa T57 m 3 m ^. 1p A w n ^n m m• o o N_ d N D a �' in• r 3 d O d T '"' y � 3 n F m `° N 0 0 3 < � N O N 3 N m D � a n 0 0 � o � s a w m o Q y d d d < w O O = 0000 5- 0 < V d O 000 OOi A N fl ' H O w w O A Z m O O w O A � � 'm d � °' v� � c c f F �• d � N m voci o n = 3m w w w fp Z C C N n 00 OOa N �. w a � G tyAi� a ^ o > > O d N O. O y o °. d 3 3 ^ c > > m O O N a w d N 9 V fl• d = N N N N C A N Z i'0 GAO � d 1plf m d D < N m o m W C m D- � a D D ti Q c m O � w � 3 two w m > T m x � o -n^ ^ m tioti ° a O D m R - n 3 0_ < 2 - _. y n n n n a'o O m c ' 3 N w w m w v O o 3 d » A O �, m Z Z ° ' m O .r m 3 m 3 N x x 9 i s �n O O O nn O D T o ^ o » n w = 9 iD ^ N p A 9 n D 3 x 2 F w N n o o m y m 3 g a j d m ID F in a 2 m 9 Sr ^ » n c o y 9 m 3 D 3 = D w �• Et m r o m m � @ w a 3 3 0 :i o03 » F3G S cmv ° m e d < 3ni � =° " m a m x aO o f .o w N N m M m N 0n m� A A m 'O mw a o m '^ V ^m (n ~ P S P A m tO N n p a VI N ? n o ° G GI — Cl y 9 VI u o O x. m u0i m m R ^ n v V N -mA-1 et m O w N W N r m n W D —' n —' n p f a w m Na m3 ^ ,o `° ID N<\ Na m 0. ? A W N F+ •_ O 1.1 0 N � m o m <9 a D n Er �+ D p m Q m c o o. 3 °o ° w N _ •+ O to A D ? d O C ry m d < c` 00 O O N vdi P ° G O R •�j „V u O = � �? N 3m 03 Er U 0 0 � m n � u a H N m n w 3 ° 'o � m' ESi oan33 � � T t n s w s m o o n - �? y o, 3 d m N a 3 ' o o O = m o vq2 o� a n N• D > 3 E_ > 3 N ° v m N o n n c a m ^ 3 —3o � 2 N o O n o ? O ? o. I ao C) n° L J d V R m V w n a —w' V 1O m V 3 N N m w O � Q £ m m m o- w A O 1�D n m ^a 3 = o v n (Tio m w No a N w 3 c o w 3 N a o 9 ? 2 R O L n d 1 m o 3 o T m 2 0 ❑� o o n w n n v o m D N a a 3 W y a m O O w v�i ❑ 1p w m t'ulldln8 it Atenlfee 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