PMT17-02960 City of Menifee Permit No.: PMT17-02960
29714 HAUN RD.
<A_CCEL/_> MENIFEE,CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 08/22/2017
PERMIT
Site Address: 29042 DESERT HILLS RD, MENIFEE, CA Parcel Number: 337-393-002
92586 Construction Cost: $15,000.00
Existing Use: Proposed Use:
Description of 3 TON COMPLETE SPLIT SYSTEM REPLACEMENT
Work:
Owner Contractor
TONY PRUIETT A R S AMERICAN RESIDENTIAL SERVICES OF
29042 DESERT HILLS RD CALIFORNIA INC
MENIFEE,CA 92586 965 RIDGE LAKE BLVD#201
Applicant Phone: 9512769744
CHRISTINA CALHOUN - License Number:765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNI)
965 RIDGE LAKE BLVD#201
MEMPHIS,.CA 38120
Fee Description Oft( 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_Pernit_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 contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o 1 am exempt from ficensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
21
Incense Clan CfO CZ-o—C'3 ZI )y
s By my signature belowlacknowledge that,except for mypersonal residence
Expires I Signatuin which l 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 COMPENSATION DECLA have built as an owner-builder if it has not been constructed in its entirety 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 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 www.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy# Date
®6-1 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 zFBy my signature below I 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
number are: application and the information I have provided is correct.I agree to comply
Carrier G with all applicable city and county ordinances and state laws relating to
4b ,ldrconstruction.i hori re esentat' (Policy# �(031 SO2Xa31011�Expires O 1 Aaveid ed p p for ins c' n pu(This section need not to be completed is the permit is for one-hundred Datedollars($100)or less A ED NT
o I certify that in the performance of the work for which this permit is issued,
I shall not emalov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE It
workers compen 'on laws of Cag mia,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subjectto the or rs cumpens" on pr r s of i 3700 of the Labor
Code,I shall f h co r th t s p isio Will the applicant or future building occupant handle hazardous material ora
Applican Date 2y
Z mixture containing a hazardous material equal to or greater that the
amounts sppecified on the Hazardous Materials Information Guide?
WARN . AILURE To SECURE WORKER'S COMPENSATION IS ❑Yes No
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 CoastAi antQuality Management Discos construction
modee ification
from
checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY o Yes ryNa
1 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) ❑yes peNo
OWNER BUILDER DECLARATIONS 1 have read the Hazardous Material Information Guide and the 5CAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements underthe State of
Contractors License Law for the reasons)indicated below by the Californpirolth&Safety MSe505 an 34 concerning
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 haze ou A,11ad rep
Business and Professions Code).Any city or county that requires a permit to D 5` 7
ate
construct,alter,improve,demolish or repair any structure,prior to its
issuance,also requires the applicant for the permit to file a signed statement TYOWNER OR AGENT
that he ar she 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 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 RRP-certified 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
a 1,as owner of the property,or my employee with wages as their sale 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 ❑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 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 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 not apply to an owner of a If your project does not comply with EPA RAP rule please fill out the RRP
Acknowledgement.
DATE 8 ZL 1-1 PERMIT/PLAN CHECK NUMBER �� O
TYPE: . COMMERCIAL V041ESIDENTIAL MULTI-FAMILY - MOBILE HOME POOLISPA SIGN
SUBTYPE: ADDITION ALTERATION DEMOLITION ELECTRICAL VMECHANICAL
> NEW ," PLUMBING RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 3_T0V1
PROJECTADDRESS Z9O�kZ "Q.e.Se.Y'T' T't \ '�L /ZS ''t1ryry
ASSESSOR'S PARCEL NUMBER LOT TRACT aTJ
OWNER NAME -7)Y U11 Tor.,n
ADDRESS O. ��b S It
PHONE EMAIL
APPLICANT NAME ��jj � 1
�E ��j� t-L. A. v o
ADDRESS L�XA_V-,4_ C>„ -TO S 1�
PHONE (g/v I) Zo y - 31 S 9�� ,,,, EMAIL
CONTRACTOR'S NAME �� (Y�+!_ OWNER BUILDER? YES PNO
BUSINESS NAME
ADDRESS '30-50 Cvh ,k-S 9
PHONE 800 (p(aO o(p'1S EMAIL
CONTRACTOR'S STATE LIC NUMBER 740,SO ZC/ UCENSE CLASSIFICATION C 10 C ZO C&p
VALUATION$ 151 OOO zi L SO FT
APPLICANT'S SIGNATURE z Zl 17
.17
CITY STAFF U5E ONLY L
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN I SMIP
tNVOICE PAIDAMOUNT
AMOUNT :JCY�'F' ' CASH CMECKp '-CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT `)CASH CHECK N CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED YES .% NO DL NUMBER NOTARIZED LETTER C YES '' NO
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