PMT17-02320 City of Menifee Permit No.: PMT17-02320
29714 HAUN RD.
�CCELh� MENIFEE, CA 92586. Type: Residential Mechanical
MENIFEE Date Issued: 07/05/2017
PERMIT
Site Address: 30341 LAMPLIGHTER LN, MENIFEE, CA Parcel Number: 364-260-027
92584 Construction Cost: $7,370.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE,THEN INSTALL 5 TON CONDENSER&COIL ONLY
Work:
Owner Contractor
DOUG WOODS A R S AMERICAN RESIDENTIAL SERVICES OF
30341 LAMPLIGHTER LANE CALIFORNIA INC
MENIFEE,CA 92584 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 O—t Amount 151
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_Perrnit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
1 hembyaffrrn 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 ❑Iam exempt from licensure under the Contractors State License Law For
Professions Code and my license is in full force and effect.
��-- the following reason:
License tlas GOB C2o 1C3 License No. L LGFJ�7q
By my signature below I acknowledge that,except for my personal residence
Expiresignature in which l must have resided for at least one year prior to completion of
WORKERS COMPENSATION DEOARATION improvements covered by this permit.I cannot legallysell a structure that 1
have built as an owner-builder if it has not been constructed in its entirety by
�jl hereby affirm under penalty of perjury one of the fallowing declarations:I licensed contractors.I understand that copy of the applicable law,Section
have and will maintain a certificate of consent ofself4risure 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
this permit is issued. wvAv.leeinFo.m.eovycalaw.htmt.
Policy It Date
o I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,For the performance of the work forwhich ❑By my signature below l certify to each of the following;)am the property
this permit is issued.My worker's compensation insuranm carrier and policy owner or authorized to act on the property owner's behaiL l have read this
numberare: application and the information l have provided is correct l agree to comply
Carver �/� GI�f N with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#ZQ50S(U61U Expi •, Ft_`7, enter the above identified property for inspection purposes.
(This section need not be completed is the permit`ls for one-nwcu,
dollars($SOD)or less Date.
PROPERTY OWNER OR AUTHORIZED AGENT
o l certify that in the performance of the work for which this permit is issued, 0 � (-- q -'7
[shall not employ any persons in any mannerso as to become subject to the CITY BUSINESS LICENSE V` 1
workers compensation laws of California,and agree that if l should become RDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shag forthwith comply with.those provisions. r11 the aoolicant or future building Occupant handle hazardous material or a
Applicant Dated 5J� - ice containing a hazardous material equal to or greater that the
�'f" amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURETOS REWORK SCOMPENSATION COVERAGE IS " - Oyes two-
UNLAWFUL,AND SHALL SUBIECFAN EMPLOYER TO CRIMINAL PENALTIES Will the intended usepf the building by the applicant or Future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($500,000),IN occupant require for construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SG1gMD)?See permitting checklist
IN SECTION 37060FTHE LABOR[DOE,INTEREST,ANDATI"ORN(YS FEES forguideliNq
nes
CONSTRUC ION LENDING AGENCY 0Yes /Nes
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 100D 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 0
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby aFfirn under penalty of perjury that l am exempt from the permitting checklist l understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 75505 and 25534 concerning
chedmtaMs)I have placed next to the applicable Ttem(s)(Section 70315 hazardous material reporting.
Business and Professions Code).Any city or county that requires.a permit to Ely ONO
construct,alter,improve,demolish or repairany structure,priortp its ��� Date
issuance,also requires the applicant for the permit to File a signed statement PROPERTY OWNER OR ♦lORI ED AGENI
that he orshe is licensed pursuant to the provisions of the Contractors State EPA RENOVATION.REPAIR AND PAINTING(RRP)
Umnse Law(Chapter 9(commencing with Section 70110)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he orshe is exempt from licensure receiving compensation for most work that disturbs paint inapre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by receivineompenarefaOor mosty to ork that disturfied bs
and comply with
an Applicant for a permit subjects the applicant to a civil pena[Wof not more r aired or
rcticecare induces rentalproperty
than($500). e9 P 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 O all oforO portion of the work,and the structure is wynv.ena.aovAead or contact the National Lead Information Center at
not intended or offered for sale(Section 7044,Business and Professions e�Nkl--1 9424-LEAD(5323).
Code;The Contractors State License taw does not apply to an owner of a OtM fit`
property who,through employees•or personal effort,builds or improves(fV An EPA Lead-Safe Certified Renovator will be responsible for this project
Property provided that the Improvements are not intended or offeref�( %Q9 Certified Firm Name:
sale.If,however,the building or improvement is sold within oneyeaiWi Q`.r Flan Certification No.:
rompletion,the Owner-Builder will have the burden of proving that It was V
hot built or Improved for the purpose of sale- o No 4PA Lead-Safe Certified Firm is required for this project because:
31,as owner of the roe
P P rtyam exclusively contracting with licensed
:antractors to construct the project(Section 7044,Business and Professions `Sd
:ode: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/PLAN CHECK APPLICATION
Menifee
DATE 7-5"/7 PERMIT/PLAN CHECK NUMBER
TYPE: MERCIAL VESIDENTIAL O MULTI-FAMILY O MOBILE HOME �O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL {MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
� I DESCRIPTION OF WORK 5 15 " f L
PROJECT ADDRESS L •/*�/ {���Q- � �� Lr^/�'r�96 5-a
ASSESSOR'S PARCEL NUMBER �4• L1.�' M LOT TRACT %�f2L
OWNER NAME Agq tjOCIAS
ADDRESS
/'
PHONE l :S) S / EMAIL
APPLICANT NAME
ADDRESS we-lz`JJldC
PHONE 1 �2(4 -646 75" EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES ONO
BUSINESS NAME -C^
ADDRESS LiZ)� ZC� t'� I UC��-.SYNC rxf 9"- 66
PHONE(J—(j5� 4061",- (1[y EMAIL
CONTRACTOR'S STATE LICNUUMBER 25t%, 7�
� /-7 LICENSE CLASSIFICATION UO CZ6 C
VALUATION$ U SOFT 3 56 L SO FT�7 /
APPLICANT'S SIGNATURE /L' DATE
DEPARTMENT DISTRIBUTION I CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN l SMIP
INVOICE �� PAIDAMOUNT
AMOUNT OCASH OCHECK# V..CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT I O CASH O CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
Citynifee
o Men/ ee Building&Safety Department 29714 Haun Rd. Meni ee, CA 92586 o MTiety
f f 4 f Y P f �I�1�dMQ-�3'�fety Dept.
www.cityofinenifee.us Inspection Request line 951-246-6213
JUL 0 5 2017
Received
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