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
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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
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