PMT18-03812 City of Menifee Permit No.: PMT18-03812
I, 29714 HAUN RD.
,F MENIFEE; CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 08/02/2018
PERMIT
Site Address: 28393 CRESTWOOD ST, MENIFEE,CA Parcel Number: 333-321-024
92585 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT,3 TON COMPLETE SPLIT SYSTEM REPLACEMENT
Work:
Owner Contractor
DELORES THOMAS A R S AMERICAN RESIDENTIAL SERVICES OF
28393 CRESTWOOD STREET 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 CALIFORNI/
965 RIDGE LAKE BLVD.#201
MEMPHIS,CA 38120
Phone: 9512769744
Fee Description 01t rr Amount 151
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 buitiding 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_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 contractols)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 3of the Business and o I am exempt from lirensure under the Contractor's State License Law for
Professions Code and my license is in full Wffe�ct. he following reason:UcenseClass ( 20 «� Uy my signature below l acknowledge that,except for my personal residence
Expires r�� Signature which l must have resided for at least one year prior to completion of
provements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLA 71ave built as an owner-builder if it has not been constructed In its entirety by
o l hereby affirm under penalty of perury one of the fallowing 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 far 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.leglnfo-u.gov/mlaw.html.
this permit is issued.
Policy# Dare
ca 10. ve and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,far the performance of the work for which ❑By my signature below I certify to each of the following:)am the property
this permit is issued.My worker's 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 1 have provided is correct.I agree to comply
Carrier�.-+l with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy It -i�n31568(03�01-Ixplms In 1, 11 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is far one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
01 certify that in the performance of the work for which this permit is issued, 0V�..c/ JJ�1 u
I shall not employ any persons in any manner so as to became subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the war e{s compe aaF7Dnyvisloins of swW370Dofthe Labor
Code,eNILUREt�l
h to i rose visi Willmix ure applcontaining
nt oring a hazeruture building occoequaltpant or dle
ousthat
material or a
mixture containing a hazardous material equal to or greater that the
ApplicaDate L amounts specified on the Hazardous Materials Information Guide?
WAROSEC WORKER'S COMPENSATI COVE GE 15 oYes yam,
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($100,00D),IN occupant require a permft for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SMMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidellnes
CONSTRUCTION LENDING AGENCY oYes "o
hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 10DO 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 `a4lo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
hereby affirm under penalty of perjury thatlam exempt from the Permitting checklist.I understand quire under the State of
[alifomI Ith&Safe Section 2 nd 25534 cancer ing
Contractor's License Law for the reasons)indicated below by the haze pus aterfal r
checkmark(s)I have placed next to the applicable Items)(Section 7031.5 s .14
Business and Professions Code).Any city or county that requires a permitto
construct,alter,improve,demolish or repair any structure,prior to Its PROP N ORIZED AGENT
issuance,also requires the applicant far the permitto file a signed statement
that he or she is licensed pursuant to the provisions of the Contractor's State A RENOVATION REPAIR AND PAINTING(RRPI
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 lirensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.S 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($500). managers who do the paint-disturbing work themselves or through their
O I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD 15323).
Code;The Contractor's State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. O No EPA Lead-Safe Certified Firm is required for this project because:
D 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License taw does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
B
DATE: 18 PERMIT/PLAN CHECK NUMBER02rol;)L
TYPE: CIIMMERCIAL c, RESIDENTIAL MULTI-FAMILY 0 MOBILE HOME POOL/SPA SIGN
SUBTYPE: ADDITION ALTERATION DEMOLITION ELECTRICAL MECHANICAL
NEW PLUMBI/N�G� ' RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORX,
PROJECTADDRESS Z ig� 1� Cf�`bTtk�00d Or_ ZIP 9Z.S8S
ASSESSOR'S PARCEL NUMBER - .�'(�a� LOT TRACT
OWNER NAMEV��n.3 �P�p�f S Building De t.
ADDRESS SAME AS JOBSITE AUG p 2yplg
PHONE / S l 7-3 ) I(,S EMAIL
APPLICANTNAME +C'L$�'I /191, �IIn.Ov>�� Received
ADDRESS SZX�
PHONE(']a zD y- 3 9 EMAIL
CONTRACTOR'S NAME RIGHTIME HOME SERVICES OWNERBUILDER7 ' YES/IZNO
BUSINESS NAME ARS
ADDRESS 3030 MYERS ST RIVERSIDE CA 92503
PHONE 800 660 0675 EMAIL CCALHOUN@ARS.COM
CONTRACTOR'S STATE LLIIC NUMBER 765074 LICENSE CLASSIFICATION C10 C20 C36
VALUATION 5 10 FT L SQ FT
APPLICANT'S SIGNATUR 8 DATE Z /B
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: � CITY OF IWENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
PERMIT FEE SMIP k I GREEN `-
PLAN CHECK FEE I INVOICE TOTAL
OWNER BUILDER VERIFIED `:YES ' NO DRIVERS LICENSE.". NOTARIZED LETTER YES NO
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