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PMT18-00836 City of Menifee Permit No.: PMT18-00836 29714 HAUN RD. Type: Residential Mechanical 4lkCCEi6 MENIFEE, CA 92586 G°"- AMt." MENIFEE Date Issued: 02/26/2018 PERMIT Site Address: 31677 MIDDLEBROOK LN, MENIFEE, CA Parcel Number: 372-442-005 92584 Construction Cost: $7,250.00 Existing Use: Proposed Use: Description of 5 TON FURNACE&COIL REPLACEMENT ONLY Work: Owner Contractor MARIA CARPENTER A R S AMERICAN RESIDENTIAL SERVICES OF 31677 MIDDLEBROOK LN CALIFORNIA INC MENIFEE,CA 92584 965 RIDGE LAKE BLVD#201 Applicant Phone: 9512769744 CHRISTINA CALHOUN License Number:765074 A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORND 965 RIDGE LAKE BLVD#201 MEMPHIS, CA 38120 Fee Description Qbf Amount f$1 Forced-Air or Gravity-Type Furnace or Burner 1 149.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Mechanical 1 7.45 $184.45 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_BIdg_Permil_Template.rpl 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 a affect he following reason: License Class 1 20 C V 0 Lic s o.Z�O By my signature below I acknowledge that,except for my personal residence Expires �� Signature in which l must have resided for at least one year prior to completion of improvements covered by this permit.I cannot legally sell a structure that I WORKER'S COMPENSATION DECLA TIO have built as an owner-bullder if It has not been constructed in its entirety by D 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 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 ,,vw,,v,leeinfo.w.eov/calaw.html. this permit is Issued. Paliry Jl Date PROPERTY OWNER OR AUTHORIZED AGENT raY1. ve and will maintain workers compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which D 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 on the property owners behalf.I have read this numberare:`— application and the information I have provided is correct.I agree to comply Carrier L,l 2.-F� with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy If 7(O3lsf o �� xpires enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT D I certify that in the performance of the work for which this permit Is Issued, o2lr-.7+.�1 LA shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE Jt V_.•..•fEJ� ) workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the wor a{s compeyeafFlir istOTS of S 3700 of the Labor Code,I shall f 'th co frF I rose visi Will the applicant or future building occupant handle hazardous material or a mixture containing a hazardous material equal to or greater that the Applican Date L amounts specified on the Hazardous Materials Information Guide? WAR N ILURETOSEC WORKER'SCOMPENSATI COVE GEIS oyes VNp 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 for guidelines CONSTRUCOON LENDING AGENCY DYes ONO 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) ❑Yes 'e4vo OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD permitting checklist.I understand equire!Date under the State of I hereby affirm under penalty of perjury that I am exempt from the Califmn' Ith&Safe action 2 25534 cancer ing Contractors License Law for the reason(s)Indicated below by the haza pus ateri'I r 960, checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 s e/ p Business and Professions Cade).Any city or county that requires a permit to construct,alter,improve,demolish or repair any structure,prior to its pROP N ORIZEDAGENT issuance,also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors State A 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 Iicensure 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 fora 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 D I,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.epa.Rov/lead or contact the National Lead Information Center at not Intended or offered for sale.(Section 7044,Business and Professions 1-BOD-424-LEAD(5323). Code;The Contractors State License Law does not apply to an owner of a DAn 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: D I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractor's 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. li — 's _I — Aft Q DATE Z Z PERMIT/PLAN CHECK NUMBER I G D V TYPE: f-COMMERCIAL >'AESIDENTIAL O MULTI-FAMILY < MOBILE HOME C POOL/SPA C SIGN SUBTYPE: C ADDITION ' ALTERATION -)DEMOLITION 0 ELECTRICAL VLMECHANICAL 0NEW -'' PLUMBING RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK S I c,e. W ''nn AA PROJECTA DRESS (p ►V�� e. OCR Lf> ASSESSOR'S PARCEL NUMBER LOT TRACT OWNER NAME ADDRESS .S CA ( cS•� PHONE 1 S7 Z —+ EMAIL APPLICANT NAME �5 `' ADDRESS zU C) JM Z S� . 91\jFZ.SlJ]� � �2SO PHONE l Soo) [160- 6-7 S r �) EMAIL ( �^ CONTRACTOR'S NAME \ il" '` �0 � SF-�UI - OWNER BUILDER? YES /NO BUSINESS NAME ADDRESS IJ y0 lvl F12.5 s I �;Iv),IIJ IQ GA PHONE gV� �b�, i� yEMAIL CONTRACTOR'S STATE LIC NUMBER ! 7 U 'f L I LICENSE CLASSIFICATION VALUATION$ Z J FT L SO FT APPLICANT'S SIGNATUR . DATE Z DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP INVOICE 14qd PAID AMOUNT AMOUNT CASH —CHECK# - CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT CASH CHECK# -=CREDIT CARD VISA/MC OWNER BUILDER VERIFIED 0 YES "% NO DL NUMBER NOTARIZED LETTER O YES 0 NO n m m n o 0 0 0 o T T D a D n m T c 2 y y o O °3 Q °, ° °- a 0 m � d o N T :. 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