PMT17-02319 City of Menifee Permit No.: PMT17-02319
29714 HAUN RD.
�L\CCEL/k� MENIFEE,CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 07/05/2017
PERMIT
Site Address: 23985 VISTA WAY, MENIFEE, CA 92587 Parcel Number: 351-084-017
Construction Cost: $12,777.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE HVAC-3 TON PACKAGE UNIT-SAME SIZE&LOCATION
Work:
Owner Contractor
JESUS NUNEZ A R S AMERICAN RESIDENTIAL SERVICES OF
23985 VISTA WAY CALIFORNIA INC
MENIFEE, CA 92587 965 RIDGE LAKE BLVD#201
Applicant Phone: 9512769744
KENNY PEERY License Number.765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIU
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
Fee Description gty Amount t$)
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 l 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 licamure under the Contractor's State License Law for
Professions Code and my license is in full force and effect/�- the following reason:
License Clam C20/9f 3&—License No. 7`y'�/
By mysignature below I acknowledge that,except for mypersonal residence
Expires1_ - :f ignature In which l must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.l cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
,p1 hereby affirm under penalty of perjury one of the fallowing declarations:I licensed contractors.I understand that a copy of the applicable late,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
by Section 3700 of the labor Code,for the performance of work for which this application is submitted or at the following website
this permit is issued. w%vw.leFimI6.ca.gov/calaw.html.
Policy 9 Date
Dl have and will maintain workees compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,For the performance of the work for which OBy my signature below l certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner Or authorized to act on the property owner's behalf.I have read this
numherare: I .f� �7 application and the information I have provided is correct I agree to comply
L---Carrier f�Glc-1 .I with all applicable cityand county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy ri7�/SnR/Ala/l! Expi J�•, J-J_� , enter the above identified property for inspection purposes.
(This section need not to be completed is the permit`is for one-nuns,
dollars($100)carless Date.
PROPERTY OWNER OR AUTHORIZED AGENT
Olcertify that in the performance of the work for which this permit is issued, ri c q
(shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE C
workers compensation laws of California,and agree that if I should become
subject to the workers compensation provisions of Section 3700 of the Labor HO(ZARDOUS MATERIAL DECLARATION
Code,l shag forthvi comply with those provisions. /Will the aoofiant or future building Occupant handle hazardous material or
Applicant tf
Date - .+recontaininga hazardous material equal to orgreatertha[the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURETO RE WOR COMPENSATION COVERAGE IS ' ❑Yes Jot`0
UNLAWFUL,AND SHALL SuBJECFAN EMPLOYER TO CRIMINAL PENALTIES
ANDOVILFINES UP TOONE HUNDRED THOUSAND DOLLARS($100,000),IN Willi end
use of the building by the applicant or future building
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST AND ATTORNEYS FEES Coast Air Quality Management District(SCAOMD)?See permitting checklist
forguidelines
CONSTRUCTION LENDING AGENCY O Yes 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?
(Section 3097 Civil Code) O Yes EI
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 checklfsLIunderstand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable ftem(s)(Section 70315 hazardous material reporting. ^�
Business and Professions Code).Any city or county that requires.a permit to oY ONO
construct,after,improve,demo8sh or repair any structure,prior to its Date J
issuance,also requires the applicant for the permit to file a signed statement PROPERTYOWNEROR F�OR12ED AGENr�
that he orshe is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Land Chapter 9 Professions
(commencing that
with Section?exempt Domlicamameon 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
and the and Professions ed Code) n.e orAny violation
is on ol`S from 7031.5 b receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation OFSection 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�oFnot more aired practices.This indudm rental property
than($500). em1 P P P rty owners and property
managers who do the paint-disturbing work themselves or through their
O1,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( )act of or I portion of the work,and the structure is wynv.eoa.govAead 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 not apply to an owner of a
O 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 090 Q00` Certified Firm Name
&
:ale.If,however,the building or Improvement is sold within one year O� S�Kit`I
:Ompletion,the Owner-Builder will have the burden of proving that it Firm Certification No.:
�Tot built or improved for the purpose of sale. 8U\ QG `���o EPA Lead-Safe Certified Fro is required for this prajec[heause: I
11,as owner of the property am exclusively contracting with licensed
xintractors to construct the project(Section 7044,Business and Professions _��
.ode:The Contractor's State License Law does not apply to an owner of a �c°33qq��gg`G
�ry06r Tfyour pmject does not comply with EPA RRP role please fill out the RRP
�O Acknowledgement
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
"Menifee
DATE 7- 5 PERMIT/PLAN CHECK NUMBER IVI I I pf
TYPE: O COMMERCIAL C RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA :I SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL-.Q-t1ECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES-
DESCRIPTION OF WORK , f`A P- J��'r�' S)
D �iOYI z A r �
PROJECTADDRESS CJ r€�� /q p`.(� / Aie I FtV L�7!T t Snz
ASSESSOR'S PARCEL NUMBER . /1 •�O -1"' � LOT r TRACT
OWNERNAME //��"
ADDRESS Sfa 5 IC,7L1 ✓e-
PHONE /F�5/) aye/-C+O�)�2 EMAIL
APPLICANT NAME EE
ADDRESS 30L26 �iQ.a� ✓ �ZLSf 04
PHONE(QIt-)61ej0- C7Cp 7-5 EMAIL
CONTRACTOR'S NAME -KCh ( OWNER BUILDER? O YES O NO
BUSINESS NAME ,^ ' F- i >
ADDRESS {�C/ P S /JC/ , r,,/
PHONE , ,� ln[l-L`110J� EMAIL
CONTRACTOR'S STATE LIC N Q UMBER 7(QSC� 741 LICENSE CLASSIFICATION C L'ZD C7306
VALUATION$ /c;? 7,77 SO FT 1219 L SQ FT -7
APPLICANT'S SIGNATURE �!� G DATE 7-S .1 /
DEPARTMENT DISTRIBUTION r CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN (• SMIP ✓
INVOICE PAIDAMOUNT
2
AMOUNT J�4•'p OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of_Menifee
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 9258wIaifidw9AIety Dept.
www.cityofinenifee.us Inspection ReguestLine 951-246-6213
JUL 0 5 2017
Received
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