PMT17-03878 City of Menifee Permit No.: PMT17-03878
_ 29714 HAUN RD. Type: Residential Mechanical
�CCEL/_> MENIFEE, CA 92586 -
"'"""""`""T` MENIFEE Date Issued: 1 013 012 01 7
PERMIT
Site Address: 28539 W WORCESTER RD, MENIFEE, Parcel Number: 339-183-001
CA 92586 Construction Cost: $14,329.00
Existing Use: Proposed Use:
Description of 5 TON HVAC REPLACEMENT W/2 SUPPLIES OF DUCT
Work:
Owner Contractor
PETER CHAMDUN A R S AMERICAN RESIDENTIAL SERVICES OF
28539 W WORCESTER RD 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 CALIFORNIo
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
Fee Description Q1t r Amount(5)
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_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 D I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect.
� -7 the following reason:
License ClasrUOpC20/[3(A_Licens No. CIOcJ� / Zy my signature below l acknowledge that,except for my personal residence
Expires, ignature_ In which I must have resided for at least one year prior to completion of
�F 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
,PI hereby affirm under penalty of perjury one of th,rollowing declarations:I licensed contractors.I understand thata 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 vnnv.leeinfo.ca.eov/calasv.html.
this permit is issued.
Policy# Date
❑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 a By my signature below l 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
numberare: application and the information I have provided is correct.I agree to comply
Cartier L( � with all applicable city and county ordinances and state laws relating to
;` }' { building construction.I authorize representatives of this city or county to
Policy# —7L�LPgO g�31iw-7 f Q s. L10/l /1 t enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hum red Date
dollars($100)or less � PROPERTY OWNER OR AUTHORIZED AGENT
a I certify that in the performance of the work for which this permit is Issued, 0 35t I�7
I shall not employ any persons in any manner so as to became 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 fcrthwith c I rrh rh..se provisions. III the anolicant or future building occupant handle hazardous material or
Y Ly[(� irecontaininga hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:F..,r.uKE TOF RE WOh.. .,oa.uMPENSATION COVERAGE IS aYes .e'er
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($100,080),IN occupant require permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCACUND)?See permitting checklist
IN SECTION 37060FTHE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes 0 o
l 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) D Yes o�
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guideand the SCAQMD
1 herebyaffrrn 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 25S05 and 25534 concerning
h ardous material reporting.
checkmark(s)i have placed next to the applicable item(s)(Section 7031.5 Y O No - r� f
Business and Professions Code).Any city or county that requires a permit to _Date 0 LLi'I
construct,alter,Improve,demolish or repair any structure,priorto its pROPERTY OWNER OR ORIZED ryxrv.
issuance,also requires the applicant for the permit to file a signed statement C-
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING MRPI
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 of5ectlon 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 penalteof not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
D1,as owner of the property,or my employee with wages as their sole employees.For more information about EPAN 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
property who,through employees'or personal effort,builds or improves the D An EPA Lead-Safe Certified Renovator will be responsible for this project
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. allo EPA Lead-Safe Certified Finn 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.
. '1
DATE d �I PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL 94ESIDENTIAL O MULTI—FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL sVMECHANICAL
C NEW O PLUMBING O RE
t—ROOF—NUMBER OF SQUARES
DESCRIPTION OF WORK %` PL M% '
Z uPPI,tE o� � ( r k PROJECTADDRESS U V - �br� -JT �r
ASSESSOR'S PARCEL NUMBER
0+ LOT JQJ
TRACT
OWNER NAME QMt>u
ADDRES VJ " ok�� ra,- Ris
PHONE EMAIL ;r„7
APPLICANT NAMED `�v t V �� V o�N
ADDRESS ST R►\jF.SIof:- cpI- 125o
PHONE (&0b) b60-D6--7S �) EMAIIL /�
CONTRACTOR'S NAME ` �I" I I m OWNER BUILDER? O YES / NO
BUSINESS NAME
ADDRESS (7 5v !`~�I m1 S �tV f fZS Ir, 1� GH ll�O
PHONE g[)� �IU� � t�EMAIL
CONTRACTOR'S STATE LICNUMBER 50 i 1-I LICENSE CLASSIFICATION
VALUATION$ H � 2 1 SQ L SO FT
APPLICANT'S SIGNATURE DATE 101
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE �'O PAIDAMOUNT ,
AMOUNT {.CASH 0CHECK# OCREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK R O CREDIT CARD VISA/MC
[OWNER BUILDER VERIFIED O YES 0 NO DL NUMBER NOTARIZED LETTER C: YES 0 NO
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