PMT14-01894 V
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City of Menifee Permit No.: PMT14-01894
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Mechanical {
MENIFEE Date Issued: 0 712 2/2 01 4
I
P E R M I T 1
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Site Address: 27065 RANGEWOOD ST, MENIFEE, CA Parcel Number: 335-425-003
92586 Construction Cost: $7,329.00
Existing Use: Proposed Use:
Description of REPLACE 80,000 BTU FURNACE 3 TON 3 A/C&COIL SAME LOCATION
Work:
Owner Contractor
THELMA GROUDAS VENVEST BALLARD INC
27065 RANGEWOOD ST 3030 MYERS STREET
MENIFEE, CA 92586 RIVERSIDE, CA 92503
Applicant Phone: 9512769744
LAURA YENOLONIS License Number: 878533
VENVEST BALLARD INC
3030 MYERS STREET
RIVERSIDE, CA 92503
Fee Description OQt Amount($)
�Forcetl Ai�r�Grav�it�'T;y,�elnaCe otx6�_rne ��y+��.���tanr `r r'•�xi;�i �� 9490'b
Air Handling/Condensing Units SFR 1 133.00
GREEN FEE 1 1.00
$310.00
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 thereunderwhen 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
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Co e and my license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class Lice se No. who builds or improves thereon, and who contracts for the projects with a
Expires—?�X_0V Signature � ' � licensed contractors)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DE TION ' s�- - ❑ 1 am exempt from Iicensure under the Contractors'State License Law for the
❑ I hereby affirm under penalty of perjury one of the following declarations:
following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in
compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have
permit is issued. built as an owner-building if It has not been constructed in its entirety by licensed
Policy# contractors. I understand that a copy of the applicable law, Section 7044 of the
I have and will maintain workers' compensation insurance, as required by Business and Professions Code,Is available upon request when this application is
ection 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:httpJ/www.Ieginfo.ca gov/calaw.htmi.
permit Is issued.My workers'compensation insurance carrier and policy number are:
Property Owner or Authorized Agent Date
Carrier i��S �Gfl 0 &P_ wt*
Expires Policy# MIC51 z✓-VA(O,a B
❑ By m Signature below, certify to each of the following: am the property
Name of Agent ���t A_ _ ��# owner or
authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
construction.I authorize representatives of this city or county to enter the above-
El I certify that in the performance of the work for which this permit is issued,I 'dentified property for the inspection purposes.
shall not emolov any persons in any manner so as to become subject to the A
workers' compensation laws of California, and agree that if I should become 'O
subject to the workers'compensation provisions of Section 3700 of the Labor p with those provisions. operty ner or Authorized Agent. Date
Code, I shall forthwith comply p
City Busi icense#
Date;y� 1"O rl�'l� Applicant
WARNING: FAILURE TO S CURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS NLA FUL, AND SHALL
SUBJECT AN EMPLOYER TO CRI A PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED Lb
USAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DYES ERIAL
OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MAT
LABOR CODE, INTEREST,AND ATTORNEYS FEES ONO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
INFORMATION GUIDE?
I hereby affirm that under the penalty of perjury there is a construction lending
agency for the performance of the work which this permit is Issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ❑NO DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS PRINT NAME:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the reason(s)indicated below by the checkmark(s)I have placed DYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s)(Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, ❑NO SCHOOL?
or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the I HAVE READ THE HAZARDOUS MATERIAL
provisions of the Contractor's State License Law (Chapter 9 (commencing with
Section 7000)of Division 3 of the Business and Professions Code)or that he or DYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from Iicensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE SE S MON 2550RIAL R P533O�ff AND 25534 CONCERNING
HAZA❑ I, as owner of the property, or my employees with wages as their sole
compensation, will do ( ) all of or ( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code; X
The Contractor's State License Law does not apply to an owner of a property
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF 1V'lENIFEE PLCK No:
29714 Haun Road Date: Data:
Menifee, CA 92586 -aa
Phone: (951)672-6777 Amount: Amoun• oa
Fax:(951)679-3843 Ck#: Ck#:
Building Combination Permit
To Be Completed !Applicant
Legal Description: Planning Case: F: L: Rt; R:
Property Address: Assessor's Parcel Number. rr�
Prcjecv snam Name: Unit#: -w Floor#:
Name: fie
_ I -u Fa%No.
Property Address; -1
Owner ,C � U it Number Zip Cod�t as
Email Atldress:
Nam • _
Applicant Addr ss: Unit Number Zip de
Emai tldress:
Name: J
_ P fie No. F No.
k-raIk — �7�h{ _Gq $
Contractor Add ss: to,� ty S Zipfrade
fA
ontramor s ity eu to i icense o. Con of Cit tat of tJantotlrla License No. Classification; t l
Number of Squares:
Square Footage 12-00
Description of Work: it
n L Lo,r 1 Cost of Work:$y
Applicant's Signature Lt
TO Be pieted By City Staff Only -
indicate As R-Rocelved or N/A-Not Applicable
5 Completes sets of fully dimension wn io sale plans which include-. t set of documents which include
❑ The Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on ad only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8'h x 11)
❑ Foundation Plan ❑ Structural Calculations
❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition` MeanslMethods
Wow Type. RepaiN RetrofiC Revision to&is6ng Permit` Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: N Units: #Stories: Will the Building Have a Basement?
Bld Code Occupancy Group Y of N
g" p y P Indicate Indicate A YES or NO Indicate all Geo-tech.Haz.Zane
At Project Construction SpdnkIW x1 that apply: Coastal Zone
Completion:
Type C 01 O YES w NO Noise Zone .
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commies Arch.Review Board Landmark Comm, Planning Comm.Zoning Administrator
Fee Exempt: City Project Elea Vehide Charger Landmark Seismic Retrofit special case ama
of cal Aopre.al
Expedite Project(s): Child Care City Project Green Building Landmark AtfordaDte Reusing
For Staff use Only
Bulldm /Safe4y Permit Speriabst City Planning Civil Fn ineenng EPWM-Admin Transportation MgmtI Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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