PMT18-01702 City of Menifee Permit No.: PMT18-01702
29714 HAUN RD. Type: Residential Mechanical
'Jr1GC+E6 MENIFEE, CA 92586
GR1MR^K:B.ik-P MENIFEE Date Issued: 04/17/2018
PERMIT
Site Address: 29291 WOODLEA LN, MENIFEE, CA Parcel Number: 340-404-006
92584 Construction Cost: $9,558.00
Existing Use: Proposed Use:
Description of REPLACEMENT OF 5 TON CONDESR&COIL ONLY, NO DUCT WORK
Work:
Owner Contractor
MARILYN EVERETT A R S AMERICAN RESIDENTIAL SERVICES OF
29291 WOODLEA 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 CALIFORNIi
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
Fee Description (0ty Amount
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.
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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
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 ❑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 CIu C20 C3(O U se o. —I' 5 C) By my signature below I acknowledge that,except for my personal residence
Expires "I Signature in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legallysell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
❑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 www.leginfo.ca.gov/ca
this permit is issued.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
o I have and will maintain worker's compensation insurance,as required by
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 policy 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 G building construction.I authorize representatives of this city or county to
Policy# I Ig bf� Q'0(01 Expires 10 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
❑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 compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers comp tion p ions of ection 3700 of the Labor
Code,I shall with co h t os ow n Will the applicant or future building occupant handle hazardous material or a
p mixture containing a hazardous material equal to or greater that the
Applicant Date C� zZ amounts specified an the Hazardous Materials Information Guide?
WARNI ALLURE TO SECUR ORKER'S COMPENSATION COVERAGE IS ❑Yes QSlto
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
CONSTRUCTION LENDING AGENCY ❑Yes "o
1 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 040
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safe Coaz:
25534 concerning
Contractors License Law for the reason(s)indicated below by the haza us terial re .ng
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5
Business and Professions Code).Any city or county that requires a permit to s Z
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construct,alter,improve,demolish or repair any structure,prior to its R OWNER OR A ORIZED 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 Contractors State EPA 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 licensure disturbs paint in a pre 1978
d that ist
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified receiving compensation for most work thatistfirms 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
❑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.gov/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 ❑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: i
❑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.
DATE y PERMIT/PLAN CHECK NUMBER l � D o�
TYPE: COMMERCIAL D-RESIDENTIAL , MULTI-FAMILY MOBILE HOME POOL/SPA SIGN
SUBTYPE: ADDITION ALTERATION DEMOLITION ELECTRICAL 1�11�ECHANICAL
NEW - PLUMBING RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS 2.9Z9 t (,Lbo6 i('G Lo . �leve *� e 1 �8 '1
ASSESSOR'S PARCEL NUMBER ��"( ��� LOT �[j _ TRACT
OWNER NAME
ADDRESS t.V-.-e-
PHONE '90 / *38 D - EMAIL
11
APPLICANT NAME t�DV,--1
ADDRESS M\1 . S) IV FASInE u)- 1250
7
PHONE (KOO) 0-u 6 7 EMAIL
CONTRACTOR'S NAME �I I�T I Mr I'UMf SCI Jl OWNER BUILDER? YES �NO
I
BUSINESS NAME
ADDRESS f S J CA
PHONE (BUJ U� �S EMAIL
CONTRACTOR'S STATE LIC NUMBER V I LICENSE CLASSIFICATION 610 11,20 L
VALUATION $ S S L SO FT
APPLICANT'S SIGNATUR DATE Y S
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ... SMIP
INVOICE 'I� pAlO AMOUNT
AMOUNT CASH -CHECK.". CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CASH CHECK tt CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED YES NO DL NUMBER NOTARIZED LETTER •% YES NO
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