PMT17-04001 City of Menifee Permit No.: PMT17-04001
29714 HAUN RD. Type: Residential Mechanical
<ACCEL/-> MENIFEE,CA 92586
W'— MENIFEE Date Issued:
11/0712017
PERMIT
Site Address: 29868 AVENIDA DE SERENO, MENIFEE, Parcel Number: 336-242-006
CA 92586 Construction Cost: $15,500.00
Existing Use: Proposed Use:
Description of 4 TON COMPLETE SPLIT SYSTEM, RELOCATING CONDENSER TO SIDE YARD
Work:
Owner Contractor
RICHARD BEILKE A R S AMERICAN RESIDENTIAL SERVICES OF
29868 AVENIDA DE SERENO 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 CALIFORNU
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
Fee Description O_yt Amount 1$1
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 PermR_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. the following reason:
License Class C I O C2o C-3(p U s No By my signature below l acknowledge that,except for my Personal residence
Expires 1 Signature in which l must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECIA J improvements covered by this permit.I cannot legallysell a structure that I
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 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 ,N,A,,,y,le=info.ca.eav/calaw.lstml.
this permit is Issued.
Policy# Date
obi have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which sFBy 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
number are: application and the information I have provided is correct.I agree to comply
Carrier L...t 1 with all applicable city and county ordinances and state laws relating to
buJldi construction.) hori re?esentat f this city or county to
Policy# i(o31508Ca31611.& Expires O 1 en r ea ve ide ea oe'rWfor ins c' npurposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less PR OW A D NT
D 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# �{
workers compen 'on laws of Calii rnla,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the or rs compass' ion Pr
r sofS 3700 of the Labor
Code,I shall o i h co th t 5 visio s. Will the applicant or future building occupant handle hazardous material or
Applican Date •__ /'Z mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARN AILURE TO SECURE WORKER'S COMPENSATION COVE GE IS 0 Yes RNO
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)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY 0 Yes P%
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 agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) o Yes ONO -
OWNER BUILDER DECLARATIONS I 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
Californ" Ith Jk Safety.Ad50S
34 concerning
Contractors License Law for the reason(s)indicated below by the hazer ou rial rep
checkmark(s)I have placed next to the applicable item(')(Section 7031.5
Business and Professions Code).Any city or county that requires a permit to s D 5` 7
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 ORA T DAGENT
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 7003)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 Rcensure 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
❑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.eye.szov/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. o No EPA Lead-Safe Certified Firm is required for this project because:
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 pleasefrll out the RRP
Acknowledgement.
J
�J
DATE It �'l PERMIT/PLAN CHECK NUMB R offqo
TYPE: O COMMERCIAL A'6RESIDENTIAL O MULTI-FAMILY C MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL VkVIECHANICAL
O NEW ON PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK y Tor%
CgLkA dL gu �
as�►-►fit r- S� c►•r
PROJECTADDRESS 7&lQIe(_% , eely\+a
ASSESSOR'S PARCEL NUMBER �J �O`Tp{"��f/ LOT Lio TRACT ' I w
OWNER NAME A -Q„I 9_1 (
ADDRESS Cti-b 'SD bloc_
PHONE g/V I -77_ -+y 3 //tt11 EMAIL
APPLICANT NAMED Fl
ADDRESS Jo • 9IU FR&Iof:- Cfj' �250S
PHONE (FWD) �60--Q�-7!S EMAIL
CONTRACTOR'S NAME \ 11" i•I TI O!'ZI; ST-F.vI OWNER BUILDER? C YES /NO
BUSINESS NAME
ADDRESS �J 0 yO N°�IF1cs S
PHONE (�U� ��� Vl7 � rrll^EMAIL
CONTRACTOR'S STATE LIC NUMBER �V -}' I LICENSE CLASSIFICATION GIU l i-z01(i
VALUATION$ OO S L SO FT
APPLICANT'S SIGNATURE • Ll
DATE 7
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ' SMIP
INVOICE O PAIDAMOUNT
AMOUNT . ' OCASH OCHECKk OCREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O.CASH O CHECK% 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO OIL NUMBER NOTARIZED LETTER 0 YES C NO
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