PMT17-02363 City of Menifee Permit No.: PMT17-02363
29714 HAUN RD. T Residential Mechanical
�1-1 'CCEI-A- MENIFEE,CA 92586 yam'
MENIFEE Date Issued:
07I1012017
PERMIT
Site Address: 30746 TIERRA LINDA CT, MENIFEE, CA Parcel Number: 360-491-032
92584 Construction Cost: $15,062.00
Existing Use: Proposed Use:
Description of HVAC REPLACEMENT 5 TON
Work:
Owner Contractor
JOHN CORONA A R S AMERICAN RESIDENTIAL SERVICES OF
30746 TIERRA LINDA CT CALIFORNIA INC
MENIFEE, CA 92584 965 RIDGE LAKE BLVD#201
Applicant Phone: 9512769744
DAVID FERGUSON License Number.765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORM
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
Fee Description tut Amount(SI
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 staled,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
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 Dl am exempt fromlicensure under the Contractor's State License law for
Professions Code and my license is in full force and efffeecct the following reason:
License tlas CjQ C20 C License No. C��74
� I,�` �,,/1� �✓�6 — By mysignatum below l acknowledge that,except for my personal residence
Expires Mignatum in which Imust have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit I cannot legallysell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
�I hereby affirm under penaltyof perjury one of the following de arations:l licensed contmdors.I understand thata copy of the applicable law,Section
have and will maintain a certificate of consent ofself4mum for worker's 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 or work for which vnnv_leeinfo.ca.eov/calaw.h[ml.
this permit is issued.
Policy It Date
o l 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 O By 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 an the property owner's behalf.I have read this
numberare: �7�,,,••� application and the information l have provided is correct l agree to comply
Carver L-..t- with all applicable city and county ordinances and state laws relating to
o building construction.I authorize representatives of this city orcounty to
Policy# &31 Sn& mf Expi ^ ,"�_ enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-nuuus� Dale.
dollars($100)or less , PROPERTY OWNER OR AUTHORIZED AGENT
o1certify that in the performance of the work for which this permit is issued, C) �5I7
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE If
workers compensation laws of California,and agree that if should become R&RDOUS MATERIAL DECLARATION
subject to the workers compensation provision of5ettion 37D0 oftheLahpr
Code,I shag fn1hw' complywith thoseprovis }. 111 the applicant orfutum building occupant handle hazardous material ora
Applicant d ate .� 7 - pre containing a hazardous material equal to orgreaterthat the
amounts specified an the Hazardous Materials Information Guide?
WARNING:FAILURETO REWOR SCOM ENSATION COVERAGE IS OYas
UNLAWFUL,AND SHALLSUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended useofthe building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN octupan[require a permit for the construction or modification from South
ADDITION TO7HECOSi OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAOMD)75ee permitting Checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES frp
oastAir ines
Qua
CONSTRUCTION LENDING AGENCY 0Yes oNo
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 o�
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 checklist l understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the CalfFpmra Health&Safety code,Section 505 an 25534 concerning
checkmark(s)I have placed next to the applicable items)(Section 70315 hazardous material reporting.
Business and Professions Code).Any city or county that requires.a permit to oY ❑No �_5-0
Date / /_
issuance,construc alsoalter,improve,demolish orfor the
structure,a prints its PROPERTY OWN ER OR f 2ED AGENT—' - - --
issuance,also requires the applicant far the permit to file a signed statement L�
that he orshe is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRP)
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 limmum receivingcompem' tlon for mostwork that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by Tesidence or childmrefaelity to he RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a dull Penalty'ofnot 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 wagesas their sole employees.For more information about EPAs Renovation Program visit
compensation,will do()all ofor( )portion of the work,and the structure is www.eoa.eovAead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80D-424-LEAD(5323).
Code,The Gontractnrs State License taw does not apply to an owner of a
p h employees' o An EPA Lead-Safe Certified Renovator Will be responsible fprthis project
property who,throug
h p yees'ar 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 orimprovement is sold within one year of - Finn 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:
❑1,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 notapply to an owner of a If your project does notcompiy with EPA RRP rile please fill out the RRP
Acknowledgement
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK D nl lJ Ft( fy 4M CNf�t
PROJECTADDRESS '307L G �/ jfm2 L(NI)A (-r
ASSESSOR'S PARCEL NUMBER Spf�- T��1'O7L LOT �"� TRACT to
OWNER NAME ' oHNj GU2U�,.Ar
ADDRESS 3o7gb j(�j1-R_tZ_ LIN9A- [jam
PHONE EMAIL
APPLICANT NAME
� �10 �rJL (TA6QP
�I ADDRESS )o (I uz1 S 1 �� j
PHONE [ `l,�D) �DyV b EMAIL /
CONTRACTOR'S NAME l(w1`��r-F 1�1bm(, SFs.��lt 5 OWNER BUILDER? OYES eNO
f
BUSINESS NAME
ADDRESS
303c) ns s (��uknSl9a C� �Z�
PHONE b�U U�� EMAIL
CONTRACTOR'S STATE LIC NUMBER V l LICENSE CLASSIFICATION '�CIO I
VALUATION$ l J ()G)- SO FT L SO FT I
APPLICANT'S SIGNATURE DATE I 0(71TY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP
AMOUNT ,Id PAIDAMOUNT
O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH OCHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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