PMT17-04307 City of Menifee Permit No.: PMT17-04307
29714.HAUN RD.
�!-\CGEL/k? MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued:
12/OS/2017
PERMIT
Site Address: 31212TWILIGHT VISTA DR, MENIFEE, Parcel Number: 372-263-001
CA 92584 Construction Cost: $12,934.00
Existing Use: Proposed Use:
Description of HVAC 5 TON/60,000 BTU FURNACE REPLACEMENT
Work:
Owner Contractor
DAVID GEIGER A R S AMERICAN RESIDENTIAL SERVICES OF
31212 TIMLIGHT VISTA DR CALIFORNIA INC
MENIFEE, CA 92584 965 RIDGE LAKE BLVD#201
Applicant Phone:9512769744
DAVID FERGUSON License Number:765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNb
965 RIDGE LAKE BLVD#201
MEMPHIS,CA 38120
Fee Description OQt Amount f$)
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 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
1 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 Contractor's State License Law for
Professions Code and my license is in full force and effect.
� -7 the following reason:
License Claw C(Qp CIO/[3(9_Licen No. Ty my signature below I acknowledge that,except for my personal residence
Expires ignature_ to 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
joI hereby affirm under penalty of perjury one of th<rollowing 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 Cade,Forthe performance of work for which vn'nv.leeinfo.ca.eav/calaev.html.
this permit is issued.
Policy# Date
O I 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 ❑By my signature below 1 certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act an the property owner's behalf.I have read this
numberare: application and the information I have provided is correct I agree to comply
L�' (,, with all applicable city and county ordinances and state laws relating to
Cartier � _ ! building construction.I authorize representatives of this city orcounty to
Policy# -A,-;Orb&31',17i5f i- "D II /J� 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
D i certify that in the performance of the work forwhich this permit is issued, 0 3567
y
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# r
worker's compensation laws of California,and agree that if l should become RDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall fc*hwirh c I uarh rt,,.se 0mvisions. n/ ill the applicant or future building occupant handle hazardous material or a
Applicant_ _Date I�-V�+ .ne containinga hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:F—.i uKETO� REWOI--o�uMPENSATION COVERAGE 15 oyes .B'a
UNLAWFUL,AND SHALLSUB1ECfAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicantarfuture building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($500,000),IN occupant permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAO1v1D)?See permitting checklist
IN SECTION 37060FTHE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY ❑Yes (3 o
]hereby affirm that under the penalty of perjury there is aconstruction 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 D�
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that l am exempt from the permitting checklist l understand my requirements under the State of
Contractor's 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 O No
construct,alter,improve,demolish or repair any structure,priarto its _Date
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR ORIZED y.ervr
that he orshe is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTrNG(RRP]
License Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe 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 penalt�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 wwny.epa.Rpy/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80D424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a ❑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. ❑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 please fill out the RRP
Acknowledgement.
1.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
DATE PERMIT/PLAN CHECK NUMBER a
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA OSIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 1/,\) RU p�t" rP L 4-(-K^0N''
PROJECTADDRESS 3I2` IL .P /�
(,�
ASSESSOR'S PARCEL NUMBER
'BER 3�a -((a�s�o� LOT ;J� TRACT �
OWNER NAME �`A"`�
ADDRESS(5('T'(' Pi ()�oE�
PHONE I go --f34o,-n " ,l 1 t �� EMAIL
APPLICANT NAME ��Kjv) `\t C�V �N �n
ADDRESS 'O o M I ST RIV U`SI cp} 250�
PHONE (900) t 0--Q6-7S EMAIL
CONTRACTOR'S NAME ` ,�" 1 i M ¢'I Or1( )T-F.Ul OWNER BUILDER? OYES /, NO
BUSINESS NAME
C 1
ADDRESS 05C) ��yr�5 -3 1 �lUf(�Irr G� ��✓'�S
PHONE OVA �lo� VCJ � fl rJEMAIL
CONTRACTOR'S STATE LLIIC4NUMBER 7 5U -(' LI LICENSE CLASSIFICATION
' GI�IL10�G
VALUATION$ \� ` 7� SO FT L SO,FT �I
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE I PAID AMOUNT
AMOUNT CASH CHECK# CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER.VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
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