PMT17-03833 City of Menifee Permit No.: PMT17-03833
29714 HAUN RD.
1 CC(EI,/71 MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 10/26/2017
PERMIT
Site Address: 26692 CALLE GREGORIO, MENIFEE, CA Parcel Number: 330-291-002
92585 Construction Cost: $4,370.00
Existing Use: Proposed Use:
Description of DUCT REPLACEMENT, 8 SUPLLIES, 1 RETURN, NOT ALTERING HEATING AND AIR SYSTEM
Work:
Owner Contractor
JAMES HENRIQUEZ A R S AMERICAN RESIDENTIAL SERVICES OF
26692 CALLE GREGORIO CALIFORNIA INC
MENIFEE,CA 92585 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 QY Amount f$1
Building Permit Issuance 1 27.00
Inspections not specified 116 116.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 5.80
$149.80
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 carded 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_Pennit_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 I am 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 Oasr CJO�C201C 3(,9—Lfcen No. �LacJ�7 }y mysignature below l acknowledge that,except for my personal residence
Expires / - 93- .Pignature_ In which i must have resided for at least one year prior to completion of
f 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
y hereby affirm under penalty or perjury one of th,-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 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.html.
this permit is issued.
Policy It Date
-
o I 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 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 an the property owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Cariier
Lt'�� (� with all applicable city and county ordinances and state laws relating to
` building construction.I authorize representatives of this city or county to
Policy g 71i��ba �iS��17�riF'A,- 1�,� �� enter the above identified property for inspection purposes.
(This section need not to be completed is the permit m for one-hun red Date
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT
a I certify that in the performance of the work for which this permit is issued, d
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSER
workers compensation laws of California,and agree that if 1 should become ZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall fc^hwlth c I uth P6^se provisions. i r. ' !( ill the aoolicant or future building occupant handle hazardous material or a
Applicant_ _Date `�! 1-6,• 1 ire mntaininga hazardous material equal to orgreaterthat the
amounts specified on the Hazardous Materials Information Guide?
WARNING:F,,.�UKETOV R!'WO1......a cuMPENSATION COVERAGE IS aYes
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 forguidelines
CONSTRUCTION LENDING AGENCY OYes __No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 100o 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 of perjury that I am exempt from the permitting checklist 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
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 h ardous material reporting.
Business and Professions Code).Any city or county that requires a permit to Y D No
construct,alter,improve,demolish or repair any structure,prior to its Date
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR ORIZED rvr
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTrNG IRRPI
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 inapre-197B
and the basis for the alleged exemption.Any violation oFSection 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 penalWof 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 mm.eaa.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 Contractor's State License Law does not apply to an owner of a aAn 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: `
❑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.
APPLICATION& SAFETY PERMIT/PLAN CHECK
Menifee
DATE PERMIT/PLAN CHECK NUMBER (� ` o�O✓
TYPE: O COMMERCIAL /RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION ALTERATION O DEMOLITION O ELECTRICAL 4/MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK ADUI/T 4PI_I*Lr MFN '`
SvepL�+FqS /4 Rfi-U 0�
PROIECTADDRESS ^^
ASSESSOR'S PARCEL NUMBER 3�o 'oI-bp�. LOT pl TRACT off( 1u
(9
OWNER NAME (SAME
ADDRESS I-
2 Uq 'L (( AL' �j'Iv��7UF-Ili Sl/ r�) GITL 7i '70
PHONE 6 2q� - p _L 5 EMAIL
APPLICANT NAMED �) `\j 0 f7�50� �n r !l r �+
ADDRESS J0 _ D M� j� R'U IL�LWo IOE CPI, t3, O
PHONE (I O 660-0 67S EMAIL'
/P[ rrVX)5b)`j a R 5• LOP'\
CONTRACTOR'S NAME \ II V '�'�OM1 ST-P.�J� OWNERBUILDER? OYES /NO
BUSINESS NAME /J L /` �/ 2
ADDRESS c� o so �(rll rjzs S r R k\j).�1Q r 6,9 %C)J
PHONE OVU � 60- V11 i� rJEMAIL
CONTRACT OR'SSTATE LIC NUMBER 5O -(' �) LICENSE CLASSIFICATION
ii �ilt1 f L1O�G
VALUATION$ ql 3�7D SO LSO FT r�
APPLICANT'S SIGNATURE DATE tolz6ll 1
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ' SMIP
INVOICE I PAID AMOUNT
AMOUNT 0CASH 0 CHECK 0CREDIT CARD VISAJMC
PLAN CHECK FEES PAID AMOUNT OCASH O.CHECK# 0CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Naun Rd. Menifee, CA 92586 951-572-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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