PMT18-01748 City of Menifee Permit No.: PMT18-01748
29714 HAUN RD. Type: Residential Mechanical
MENIFEE, CA 92586
c,P°Mn-yes ` M MENIFEE Date Issued: 04/19/2018
PERMIT
Site Address: 27693 ADAMS AVE, MENIFEE,CA 92585 Parcel Number: 329-203-008
Construction Cost: $7,000.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, 12K BTU MINI SPLIT SYSTEM
Work:
Owner Contractor
MARIO NA A R S AMERICAN RESIDENTIAL SERVICES OF
27693 ADAMS AVE CALIFORNIA INC
MENIFEE, CA 92585 965 RIDGE LAKE BLVD#201
Applicant Phone:9512769744
CHRISTINA CALHOUN License Number:765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNb
965 RIDGE LAKE BLVD#201
MEMPHIS, CA 38120
Fee Description Q�t[ Amount($)
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
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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
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force a ffect. he following reason:
License Class 20 C3Ca Lic s o. �� By my signature below I acknowledge that,except for my personal residence
Expires LSD>' Signature in which I 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-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 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 www.lesinfo.ca.Qov/calaw.html.
this permit is issued.
Date
Policytf
PROPERTY OWNER OR AUTHORIZED AGENT
-v'l h ve and will maintain workers 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 workers compensation insurance carrier and policy owner or authorized to act on the property owners 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 Lt ro'w` �c�� building construction.I authorize representatives of this city or county to
Policy# -1(n3I S-6NOVOO�xpires LD I 1 11 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is or 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, (1;�rl LA
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# off
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the w�o ens compe n p S o7Date
3700 of the Labor
Code,I shall f):f !jth co Z oP
ovise Will the applicant or future building occupant handle hazardous material or a
�� mixture containing a hazardous material equal to or greater that the
Applican L amounts specified on the Hazardous Materials Information Guide?
WAR N ;lLiUROETOSECU�WORK�ER'S%COMPENSATI(>N/COVERA/GEIS ❑Yes �!No
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($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes !�P4fo
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) ❑Yes 'r.$to
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting check5q7Date
under the State of
I hereby affirm under penalty of perjury that 1 am exempt from the Californ�e Ithnd 25534 concer ing
Contractors License Law for the reason(s)indicated below by the haza od u" s "ate
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 s Business and Professions Code).Any city or county that requires a permit to
construct,alter,improve,demolish or repair any structure,prior to its PROP N 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 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 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
o 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.er)a.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
❑No EPA Lead-Safe Certified Firm is required for this project because:
not built or improved for the purpose of sale.
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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: _ _� (� PERMIT/PLAN CHECK NUMBER� $— do L
t— PLANNING CASE NUMBER
TYPE: COMMERCIAL V-RESIDENTIAL MULTI-FAMILY MOBILE HOME POOL/SPA SIGN
SUBTYPE: ADDITION ALTERATION DEMOLITION ELECTRICAL KMECHANICAL
NEW PLUMBING RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK Z , YV\A yY,� lap 5 ��
l
II PROJECT ADDRESS ` 71 ?j { 'u ` ZIP p� 5
I
�I ASSESSOR'S PARCEL NUMBER / 'p�/3� �� LOT TRACT
OWNER NAME
ADDRESS Z-i� „�� PCGo�.irvt5
City of Menifee
PHONE� S1 �=�p 9 9 EMAIL Building Dept.
APPLICANT NAME
APR 7n�Q
( �a �-�
ADDRESS cj� GvS G C�
PHONE EMAIL Received
CONTRACTOR'S NAME OWNER BUILDER? YES9-
Ii
BUSINESS NAME
Q
ADDRESS CX) �i �SL _ �LI V /ZSrC}
PHONE 960 (06 0 Ca-Z b EMAIL
I n
CONTRACTOR'S STATE LIC NUMBER �� 7� LICENSE CLASSIFICATION C�10 r`ZO C 3Cp
VALUATION $ -7(DQ() SQ L SQ FT
APPLICANT'S SIGNATURE DATE J �8
6iiP, i ii-i aV i! I
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERIP FIRE
vAb I
INVOICE TOTAL 3 GREEN SMIP x
OWNER BUILDER VERIFIED YES '=` NO DRIVERS LICENSE H NOTARIZED LETTER YES '` NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
Gry oa
www.cityof men ifee.LIS
MENIFEE
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