PMT17-02863 City of Menifee Permit No.: PMT17-02863
t 29714 HAUN RD. Type: Residential Mechanical
d�CCEk7 L/ MENIFEE, CA 92586
MENIFEE Date Issued: 08114/2017
PERMIT
Site Address: 26510 APPLE CREEK RD, MENIFEE, CA Parcel Number: 338-110-010
92586 Construction Cost: $9,879.00
Existing Use: Proposed Use:
Description of HVAC REPLACEMENT, 3 TON COIL/CONDENSER, MOVE TO BACK OF HOUSE
Work:
Owner Contractor
MONTY CAMARANO A R S AMERICAN RESIDENTIAL SERVICES OF
26510 APPLE CREEK ROAD CALIFORNIA INC
MENIFEE,CA 92586 965 RIDGE LAKE BLVD#201
Applicant Phone: 9512769744
DAVID FERGUSON License Number: 765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNII
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
Fee Description O_yt Amount($
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_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 I am under provisions of with a licensed contactors)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 Claw f=(O,C2b Jif 3['�Licens No. �(c7 Ty my signature below l acknowledge that,except for my personal residence
Expires 1 C5b-)`ignature_ In which l must have resided for at least one year prior to completion of
WORKER'S�+C+OMPENSATIOFN DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
�1 hereby affirm under penalty of perjury one of th.rollowing declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent ofself4mure 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 tabor Code,for the performance of work for which v�,,�v.leeinFo.ca.eov/calaw.html.
this permit is Issued.
Policy# 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 for which o By my signature below I 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 owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Cartier ��� with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#7�.L—]nSC/m (L Expi I T� . enter the above identified property for inspection purposes.
(This section need notto be completed is the permit$for one-hundred Date
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT )/
D I certify that in the performance of the work for which this permit is issued, ® 3 5 6 7 y
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# /
workers compensation laws of California,and agree that if I should become RDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall fc-hwith co ywith those provisions. ill the applicant or future building occupant handle hazardous material or a
Applicant_ _ Date xr�cc_�. .ne containing a hazardous material equal to or greater that the
�f'� amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURETO IRE WORK Sl:lt' COMPENSATION COVERAGE IS o Yes
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the 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 SECNON 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY ❑Yes �o No
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 1 have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty or perjury that I am exempt from the permitting checkllsL I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
h ardous material reporting. _
checkmark(s)I have placed next to the applicable Rem(s)(Section 7031.5 Y ❑No
Business and Professions Code).Any city or county that requires a permit to _Date
construct,after,Improve,demolish or repair any structure,prior to its PROPERTY OWNER OR ORIZEDJy� ,
issuance,also requires the applicant for the permitto file a signed statement C!
that he orshe is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRPI
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 childore facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penaQor not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
❑1,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( )all of or( )portion of the work,and the structure is www.eoa.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 of a OAn 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. O No EPA Lead-Safe Certified Firm is required for this project because:
o I,as owner of the property am exclusively contracting with licensed .
contactors to construct the project(Section 7044,Business and Professions
Code:The Contactors 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.
APPLICATION& SAFETY PERMIT/PLAN CHECK
Menifee
DATE /I"l l PERMIT/PLAN CHECK NUMBER Oa- (,Q3
TYPE: [—]COMMERCIAL RESIDENTIAL MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION [-]ELECTRICAL PIMECHANICAL
[-]NEW ❑PLUMBING FIRE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK r0^ GVI"� f C�I� (LF/ c�rr it-
DESCRIPTION
3ttcIk o f vtovW- �)D0 DOcof"c t)r �o�
PROJECT ADDRESS 2& 5t D A f P1f( RF(I(_ go Q
ASSESSOR'S PARCEL NUMBER 3'% - N\p- nQ LOT TR)QjI City of Menlf9e
PROPERTY OWNER'S NAME Ov CFFMJ12`ANo
ADDRESS ,p�V Q0
PHONE IdtS q 56-05I-1 L-f EMAIL Receive
APPLICANT NAME L) FFn JJ 0/�)
ADDRESS
PHONE pJO� �U'�u� j r EM/�AIL
CONTRACTOR'S NAME t(,��CT[�� &r< F2V/�e�wNERBUILDER? ❑YESeNO
BUSINESS NAME /1
ADDRESS ��))-�Jo3c- ��//I,YF S s7- WrzL;I/JF. (H' J ZSb 3
PHONE r;*) 660 -0(,7 S c -7 EMAIL
CONTRACTOR'S STATE LIC NUMBER ! b O /�'I LICENSE CLASSIFICATION GLolt
VALUATION$ S L SQ FT
APPLICANT'S SIGNATURE DATE I�
rmrlmm"l -Opp
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOICE PAID AMOUNT y�
AMOUNT O CASH O CHECK# CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT "CASH 0CHECK# CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED ^YES 0 NO DL NUMBER NOTARIZED LETTER .0 YES O NO
City Of,Menifee 9,Wrfing _Rv Sa{ety nen^-anent 29714 Noun Rd. Menifee, CA 92586951-672-6777
ci., ,_. _ -equest Line 951-246-6213
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