PMT17-03890 City of Menifee Permit No.: PMT17-03890
29714 HAUN RD.
<ACCEL;;�? MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued:
10/31/2017
PERMIT
Site Address: 27365 DEL MONTE LN, MENIFEE,CA Parcel Number: 336-231-014
92586 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of 2.5 TON SPLIT SYSTEM REPLACEMENT
Work:
Owner Contractor
ELLIOT LACHER A R S AMERICAN RESIDENTIAL SERVICES OF
27365DEL MONTE LN 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 GALIFORNU
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
Fee Description Qtv Amount ISl
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 building 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_Penmit 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).
I 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 Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class GlO C2o C'3 CO Li s No By my signature below lacknowledgethat,except for my personal residence
UZ
Expires i 1 Signature inwhich l must have resided for at least one year pdarto completion of
improvements covered by this permit.I cannot legallysell 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-Unsure 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 of work for which w„�,w,leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy# Date
obi 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 94y 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 carrel I agree to comply
Carrier ' with all applicable city and county ordinances and state laws relating to
buildi construction.) hon re esentat f this city or county to
Policy# '7(03150£(a31011n Expires 10 I en r e a ve ide d p p for ins c' n purposes.
(This section need not to be completed is the permit is for one-hundred Date S �7
dollars($100)or less pR OW A ED NT
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 It -• �—
workers compen 'on laws of Call rma,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the or rs compen; ron Pr
r sofS i 3700 of the Labor
Cade,1 sha11 o i h co r th t s pr visto Will the applicant or future building occupant handle hazardous material ora
mixture containing a hazardous material equal to orgreater that the
Applican Dale Y amounts sppecified on the Hazardous Materials Information Guide?
WARN . ALLURE TO SECURE WORKER'S COMPENSATION COVE GE IS oyes o
UNLAWFUL,AND SHALL SUBIECF AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant orfuture building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
IN SEC ION 3 THE COST LABOR CODE,INTERTION,DAMAGESDATTORNEYS
EYSFEES
FOR Coast Air Quality Management District(SCAQMD)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,ANDRTTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes VNo
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) o Yes Ho
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
hereby affirm under penalty of perjury that I am exempt from the
permitting checklist.I understand my requirements under the State of
Californ Ith&Safety de,Se S05 an734 concerning
Contractors License Law for the reason(s)indicated below by the haza u rial rep
checkmark(s)I have placed next to the applicable item(s)(Section 7031.S
Business and Professions Code).Any city or county that requires a permit to
construct,alter,improve,demolish or repair any structure,prior to its ate
kGPElIissuance,also requires the applicant for the permit to file a signed statement T'yOWNER OR AGENT
that he or 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 ownersand 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 o 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. _ 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.
DATE 10 --sib1 PERMIT/PLAN CHECK NUMBER
TYPE: '>COMMERCIAL tARESIDENTIAL O MULTI-FAMILY MOBILE HOME C POOL/SPA SIGN
SUBTYPE: ADDITION c ALTERATION 0 DEMOLITION % ELECTRICAL DO-MECHANICAL
;. NEW 0PLUMBING RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Z•S To-rn
V 1 q
PROJECTADDRESS Z-( 1.7" 2N e-
.cwsk- • L-n / S
ASSESSOR'S PARCEL NUM�BER� b,/(y -Q1 3m LOT � TRACT 1rJ�g'�J�
OWNERNAME �O.UV.¢.'i(- E, Sy
ADDRESS Z"1 Lf N .
PHONE 151 - S EMAIL
APPLICANT NAME irj'8-T1
ADDRESS �)o o M ST , 9 \j FRSIil1: cry
PHONE (?Oo) �,190-D6-7IS r EMAIL �^
CONTRACTOR'S NAME "I`� 1'- �r�f �T-�`Ul OWNERBUILDER? %YES /NO
BUSINESS NAME r r / Q
ADDRESS �iJ 5� IwY�J'cs 5 I r �IV'`IV C OI✓ G� i 250•� _
PHONE OUP ��U � r,^EMAIL _
CONTRACTOR'S STATE LIC NUMBER 7 U T L I LICENSE CLASSIFICATION LIU/L20l(�
VALUATION$ SO 47 L SQ FT
APPLICANT'S SIGNATURE DATE l0 151 ? -7
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN �I SMIP
INVOICE PAIDAMOUNT
AMOUNT ' C CASH 'CHECKR CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT C CASH 'O CHECK H 'O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES ^ NO DL NUMBER NOTARIZED LETTER O YES ^ NO
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