PMT18-01101 City of Menifee Permit No.: PMT18-01101
29714 HAUN RD.
�CCELR- MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 03/12/2018
PERMIT
Site Address: 26714 TROPICANA DR,MENIFEE, CA Parcel Number: 331-400-063
92585 Construction Cost: $9,000.00
Existing Use: Proposed Use:
Description of REPLACE 4 TON COMPLETE HVAC SPLIT SYSTEM
Work:
Owner Contractor
CATHERINE TRACY A R S AMERICAN RESIDENTIAL SERVICES OF
26714 TROPICANA DR CALIFORNIA INC
MENIFEE, CA 92585 965 RIDGE LAKE BLVD#201
Applicant Phone:9512769744
CHRISTINA CALHOUN License Number:765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNP
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
Fee Description Oft 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_Permit_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
Chapter!)(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 a ffect. WBIV
e following reason:
License Class ( 2D CV. Lic a.Wl4 my signature below I acknowledge that,except for my personal residence
Expires Signature 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 DEC LA 710 have built as an owner-builder if it has not been constructed in its entirety by
a I hereby affirm under penalty of penury one of the following declarations:I licensed contractors.I understand that a copyof 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 www.leginfo.ca.eov/calaw.html.
this permit is issued.
Policy tl Date
Tdttruve 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 I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and polity owner or authorized to act on the property owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
` with all applicable city and county ordinances and state laws relating to
Carrier Ll rd�` building construction.l authorize representatives of this city or county to
Policy It ��o3lSC1o�O� xpires enter the above identified property for inspection purposes.
(This section need not to be completed Is the permit is 1,,one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
a 1 certify that in the performance of the work for which this permit Is issued, O �u
I shall not employ any persons in any manner so as to became subject to the CITY BUSINESS LICENSER i.�...c/
worker's compensation laws of California,and agree that if I should became HAZARDOUS MATERIAL DECLARATION
subject to the wars compe eeTjm vTRmns of 3700 of the Labor
Code,I shall f fE�sv'th co i- (pse owsl Will the applicant or future building occupant handle hazardous material or a
(/ l% mixture containing a hazardous material equal to or greater that the
Appllcan DateACOVE
amounts specified on the Hazardous Materials Information Guide?
WAR N • ILURETOSE[ WORKER'S COMP ENSATE IS oyes VF90
UNLAWFUL,AND SHALLSUBIECT 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
CONSTRUCTION LENDING AGENCY DYes typo
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility he 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 IS410
OWNER BUILDER DECLARATIONS 1 have read the Hazardous Material Information Guide and the SCAQMD
l hereby affirm under penalty of perjury that lam exempt from the permitting checklist.I understand equire under the State of
Californ' a Ith&Safe ec ion 2 nd 25534 cancer ing
Contractor's License Law for the reason(s)indicated below by the bozo ous ,lariat
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.S s y p
Business and Professions Code).Any city or county that requires a permit to Date L `Ile
construct,alter,improve,demolish or repair any structure,prior to its PROP N ORIZEO AGENT
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 Contractor's State A RENOVATION.REPAIR AND PAINTING IRRPI
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 owners and property
than($500). managers who do the paint-disturbing work themselves or through their
D I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( I all of or( )portion of the work,and the structure is www.ena.eovAead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a D An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
D 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement
SAFETYBUILDING & PERMIT/PLAN CHECK APPLICATION
-r.
DATE 4 L I a PERMIT/PLAN CHECK NUMBER I$ Ilal
TYPE: COMMERCIAL 1>4RESIDENTIAL MULTI-FAMILY MOBILE HOME C POOL/SPA SIGN
SUBTYPE: ADDITION ALTERATION DEMOLITION '' ELECTRICAL "ECHANICAL
NEW PLUMBING ' RE-ROOF`-NU-MBEROFSQUARES
DESCRIPTION OF WORK L4 »
PROJECTADDRESS Z(o I
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME _)r l..G�,
ADDRESS Szn-V -�--7
PHONE /tSI 9 "' 9TJ�I� EMAIL
APPLICANT NAME Oa
rn n
ADDRESS �� (� Y ST AIQ FRSIr�T Cpi, 1250S
PHONE � ��1 0"06_ S r �J EMAIL ( �^
CONTRACTOR'S NAME ' 1I " �T I M,` T 011f OWNER BUILDER? ; YES /NO
BUSINESS NAME
ADDRESS c� o o rj" rRs 5 `�%v J.IV Ir c GA 11;7�
PHONE r, EMAIL
CONTRACTOR'S STATES LIC NUMBER /�] 5 0 Ty &I LICENSE CLASSIFICATION LIU/L10�.G
VALUATION$ ts
L SO,FT
APPLICANT'S SIGNATUR DATE !L IC)
DEPARTMENT DISTRIBUTION I ' CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ' SMIP
INVOICE PAID AMOUNT
AMOUNT CASH ' CHECK X -. CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT -::; CASH ',>CHECK R CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED YES NO DL NUMBER NOTARIZED LETTER 0 YES O NO
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