PMT17-01655 City of Menifee Permit No.: PMT17-01655
29714 HAUN RD.
�CCEL A'> MENIFEE,CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 06/2512017
PERMIT
Site Address: 31299 SHADOW RIDGE DR, MENIFEE, Parcel Number: 372-240-002
CA 92584 Construction Cost: $12,000.00
Existing Use: Proposed Use:
Description of 5 TON COMPLETE SPLIT SYSTEM
Work:
Owner Contractor
KAREN JAMES A R S AMERICAN RESIDENTIAL SERVICES OF
31299 SHADOW RIDGE DR CALIFORNIA INC
MENIFEE,CA 92584 965 RIDGE LAKE BLVD#201
Applicant phone:9512769744
CHRISTINA CALHOUN License Number:765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIi
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
Fee Description Qtv Amount($)
Forced-Air or Gravity-Type Fumace 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_Pennit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
1 hereby affirm under penalty of perjury that I am under provisions of with a licensed contractorls)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from Rcensure under the Contractors State License Law for
Professions Code and my license is in full farce and effect. the following reason:
License ClassClo C70 imle U � s N . By my signature below l acknowledge that,except for my personal residence
Expires U 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 C!MPENUSATIQ�N�QECLAJR�� have built as an owner-builder if it has not been constructed in its entirely 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 ofthe 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 wcnv.les:info.ca.aov/calasv.lstml.
this permit is Issued.
Policy N Date
,Wfhave 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 D By 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 owners behalf.I have read this
numberare: `�^� application and the Information l have provided is correct.I agree to comply
Carrier ,LTV+ •em�ss` - with all applicable city and county ordinances and state laws relating to
^@1 ` building construction.I authorize representatives of this city or county to
Policy g7[o3MONOMaM 1 lO Expires 1D ) 1, 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
D I certify that in the performance of the work for which this permit is issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE P,
workers compensation laws of California,and agree that if l should become HAZARDOUS MATERIAL DECLARATION
subject to the rkees comp4patia isians coon 3700 o the la r
Code,Ishal o w he d wit epo ' s. Will the applicant or future building occupant handle hazardous material or
/ /'� mixture containing a hazardous material equal to or greater that the
Appo Oate amounts specified on the Hazardous Materials Information Guide?
WARN G: RE TO SEC ORKER'S COMPENSATION VE E15 oyes ytNo
UNLA L,AND SHALLSUeIECTAN EMPLOYER TO CRIMINALPENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($200,000),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 a Yes gNcr
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1DD0 feet of the
lending agency for the performance of the work which this Perm it is issued outer boundary of a school?
(Section 3097 Civil Code) o Yes ci710
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&Safe e, 0 2550 n 25534 concerning
Contractors License Law for the reasons)Indicated below by the hazaM
rialr 0 I
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 r65'eBusiness and Professions Code).Any city or county that requires a permit to teconstruct,alter,Improve,demolish or repair any structure,prior to its ROWNER R A RIZED4AGT?
Issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions ofthe 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 RRPcertLfied 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
o 4 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 l )all ofor( Iportion ofthe work,and the structure is www.epa.eov/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 ofa aAn 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 issold within one yearof 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. D No EPA Lead-Safe Certified Firm is required for this project because:
D 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 RAP rule please fill out the RAP
Acknowledgement.
Menifee
DATE S Zr `I PERMIT/PLAN CHECK NUMBER ( I '
TYPE: ❑COMMERCIAL ❑RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ®.MECHANICAL
❑NEW ❑PLUMBING FIRE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK S Ta0%
PROJECTADDRESS 3� � 1
Z,9' aOW `tZ., '� �• ��``�
ASSESSOR'S PARCEL NUMBER ✓,p� p ��aDL T TRACT 2)(V7 b-
PROPERTY OWNER'S NAME
ADDRESS /W1�--L-
PHONE(5��) -y( Jr— 7aVo(n EMAIL
APPLICANT NAME
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)660-0675 EMAIL
CONTRACTOR'S STATE LIC NUMBER 765074 LICENSE CLASSIFICATION C10 C20 C36
VALUATION$ I Z 000 L SQ FT
APPLICANT'S SIGNATURE DATE Zb /
orI
DEPARTMENT DISTRIBUTION t1 �p CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN 1 SMIP
INVOICE PAID AMOUNT
AMOUNT .'O O CASH O CHECK N - CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK R O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES " NO DL NUMBER NOTARIZED LETTER 0 YES O NO
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