PMT17-03055 City of Menifee Permit No.: PMT17-03055
29714 HAUN RD.
41ACCIll MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 08/29/2017
PERMIT
Site Address: 29624 VIA NARAVILLA, MENIFEE, CA Parcel Number: 336-282-019
92586 Construction Cost: $14,346.00
Existing Use: Proposed Use:
Description of 3 TON COMPLETE SPLIT SYSTEM REPLACEMENT, NO DUCT WORK
Work:
Owner Contractor
KRISTA SINGLETON A R S AMERICAN RESIDENTIAL SERVICES OF
29624 VIA NARAVILLA 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 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_61dg_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or Improves thereon,and who Contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
1 hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractors Slate License Law for
Professions Code and my license is in full fora and effect. the following reason:
License Class Iu CZO C3(10 L 'ise o. ��`L By my signature below I acknowledge that,except for my personal residence
Expires -iSignature ✓ in 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 DECLARATION 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 ,w„N_leeinfo.ca.eovfcalaw.htmL
this permit is issued.
Policy k Date
PROPERTY OWNER OR AUTHORIZED AGENT
o I have and will maintain workers compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which o By my signature below 1 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 l have provided is correct l agree to comply
Carrier Lt1n-e,l 1 with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or County to
Poliryg 7ln�LS i)� DIL{Expirrs �0� l� enter the above identified property for inspection purposes.
(This section need not to be completed is the permit Is orY one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE 8
workers compensation laws of California,and agree that if i should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compe s tfon p ions of ectfon 3700 of the Labor
Code,I shall with co th osp p2 vi- n p Will the applicant or future building occupant handle hazardous material ora
Applicant U Date U ZZ jp mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials information Guide?
WARNI AILURETOSECUR RKER'SCOMPENSATIONCOVERAGEIS ❑Yes 0440
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 SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY DYes E"a
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 agencyfor the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) o Yes tsobb
OWNER BUILDER DECLARATIONS 1 have read the Hazardous Material Information Guide and the SCAQMD
i hereby affirm under penalty of perjurythatlam exempt from the permitting checklist.I understand my requirements under the State of
California Health&Safe Cade,S I n 25505 25534 concerning
Contractor's License Law for the reason(s)indicated below by the haza us terial re 'ng� ,
check actor's)I have placed next to the applicable item(s)(Section 7033.5
Business and Professions Code).Any city or county that requires a permit to s o
construct,alter,Improve,demolish or repair any structure,priorto its Date
Issuance,also requires the applicant for the permit to file a signed statement R OWNER ORA ORIZED Do
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting RAP)Rule requires contractors
Business and Professions Code)orthat 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 chfldam 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
o I,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 I )portion of the work,and the structure is ww%v.epa.eoy/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAO(5323).
Code,The Contractors State License Law does not apply to an owner of a DAn 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. D No EPA Lead-Safe Certified Firm Is required for this project bemuse:
O I,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 RRP rule please fill out the RRP
Acknowledgement.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
4
DATE PERMIT/PLAN CHECK NUMBER r ��� `O
TYPE: COMMERCIAL O,&RESIDENTIAL MULTI-FAMILY MOBILE HOME o POOL/SPA SIGN
SUBTYPE: ADDITION ALTERATION DEMOLITION ELECTRICAL `MECHANICAL
- NEW PLUMBING RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 3 Tc •
PROJECTADDRESS Z. LID?- �%l) '� /{� o. y
ASSESSOR'S PARCEL NUMBER ". (O �7c -�/`CVOT TRACT 5
OWNERNAME J„ `Q, ``V- Y'
ADDRESS [�� a G..`rwSti>Z
PHONE C �v(� -I(OCF - Zi lbZC) EMAIL
APPLICANTNAME
ADDRESS qfS�M.-KL AS +rm"�
PHONE WI) zoy- 3r -L,9 EMAIL
CONTRACTOR'S NAME OWNER BUILDER? YES DNO
BUSINESSN�A2ME p A,rz.
ADDRESS O 5�. N. 7- S0�
PHONE C�jOQ ,(p(pQ- OCy-7j EMAIL
CONTRACTOR'S STATE LIC NUMBER 7evb 1)•7,L/ LICENSE CLASSIFICATION CJO C ZO G
VALUATION$ I L/ L SQ FT
APPLICANT'S SIGNATURE ��::)6�E7�DATE S Z 7
r
i ♦ r. I '
DEPARTMENT DISTRIBUTION CITY OF MENIfEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP
INVOICE PAIDAMOUNT
AMOUNT � CASH CHECK M ' CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CASH CHECK If '-?CREDIT CARD VtWMC
OWNER BUILDER VERIFIED 1:%YES NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
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