PMT14-02189 i
City of Menifee Permit No.: PMT14-02189
29714 HAUN RD.MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 0 8/1 912 01 4
PERMIT
Site Address: 28560 DEL MONTE DR, MENIFEE, CA Parcel Number: 337-202-013
92586 Construction Cost: $12,000.00
Existing Use: Proposed Use:
Description of REPLACE HVAC, 2-TON A/C AND 45,000 BTU FURNACE
Work:
Owner Contractor
JERRY WALKER COOL AIR SOLUTIONS INC
28560 DEL MONTE DRIVE 41162 SANDALWOOD CIR STE 101
MENIFEE, CA 92586 M U RRI ETA, CA 92562
Applicant Phone: 9516762665
MORIAH NEUGEBAUER License Number: 874502
COOL AIR SOLUTIONS INC
41162 SANDALWOOD CIR STE 101
MURRIETA, CA 92562
Fee Description Q_ty, Amount 1$1
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 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_Templ ate.rpt Page 1 of 1
i
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 Code 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 Cl ss License N e `2 who builds or improves thereon, and who contracts for the projects with a {
Expires 042115 Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION D ANRA ON
❑ I am exempt from licensure 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. bullt 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
9_'f have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application Is
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto�//www.leginfo,ca4ov/calaw.htmi.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier �jLP�otl' Property Owner or Authorized Agent Date
Expires__ / 4 Policy# aOool,514//4
Name of Agent Phone# Elmy Signature below, certify to each of the following: am the property
owner
r 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 aut rize 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 identified property f r the inspection purposes.
shall not emolov any persons In any manner so as to become subject to the
workers' compensation laws of California, and agree that if I.should become - y
subject to the workers'compensation provisions �Section 3760 oF't e Labor
/o Property w c uthorized Agent D to
Code,I shall forthwith comply with those proviso �1
d
City Business License# cj ,3'J
Date; - Applicant; ,
WARNING: FAILURE TO S CUREZZ� RKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNL FUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, E]YES OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending INFORMATION GUIDE? -
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Cade) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ❑NO DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS GUIDE LINES
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed AYES 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
provisions of the Contractor's State License Law (Chapter 9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or ❑YES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure 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 I .NO - UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than ($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDO S MATERIAL REPOR'�INQ,
compensation, will do ( ) all of or( ) porting of the work, and the structure is PROP TY 0'..NCR ORAU�THORIZED AGENT
not intended or offered for sale.(Section 7044, Business and Professions Cade;
The Contractor's State License Law does not apply to an owner of a property X
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 'O Mi'.N 1 FEE PLCK No: Permit No:
29714 Haur, Road r
City of Megiiee a o.
✓le l i (- I ;Z bb Building & Safety Dept• 1
Phone: (9511572-6777 nmeJ
Fax:(951 )679-3843 AUG 19 2014 310�
Ck#ggip
eived
To Be Completed By Applicant
Legcl Description: Piann.ny Case. F. L. R
Properly Address: Assessor's Parcel Number
Zbsreo I, .337Zo2o/3
Project/Tenant Name: T • f Unit#: Floor k:
Name: �„ ✓/f�/ Ph��yos33 Fax No.
Ju
Property Address: lCG^ Unit Nu/tuber Zip Co
Owner $
up
Email Address:
Name:/I t i , rt,"
PhAnef o��i0'ZlDt05 F%mil-Ho7�G�2�®
Applicant Address: Unil N er I
411 C�25nnldal wood �r -4101 vim/%PTA Zi p Code
73Za Z
Email Address: ! -
inoriah &Coo1lb;>tr.T-tops-..
Name:' fir SolAll q -v�
Contractor Address: 116Z 6"de4f w000 ^ -r 9 /®� City // j_ Stay Zip Co,( 5G2-
(se /6/IUPf/PJr1 ( 'f�
Contractor-s Cfty_Business License No. Ca rtractror's Cit S to of California license No. Classification-
�351 33
Number of Squares:
Square Footage �/ �] II l
Description of Work: �/ �4CC//7 ' f Cost of Work:$
4
Applicant's Signature
Dater
!> = - To Be Completed By City Staff Only
Indicate As R-Received or NIA-Not Applicable
5 Completes sets of fully dimensioned,drawn to sale plans which include. t se!of documem L^,which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Goo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 61/,x 11)
Foundation Plan ❑ Structural Calculations
❑ ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for ales.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code. Indicate New Construction Alteration' Addition` Means hlemods
Work Type: Repair` Retrofit' Revision to Existing Permit' Required? YES NO
Proposed Building Use(s): Existing Building Use(s).
#Buildings. #Units: #Stories: Will the Building Have a Basement?
Y of N
Bldg. Code Occupancy Group hidicale Ind; i! YES or NO Indicate all Geo-tech. Haz.Zone
At Project Construction Spnnklered that apply: Coastal Zone
Completion: Type(s): C Of o Noise Zone
Required? YES or NO
Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS Costal Commiss Arch_Review Board Landmark Comm. Planning Comm. Zoning Administrator
Fee Exempt City Project Elec VehiGe Charger Landmark Seismic Retrofit special Case.clog.
Leiria Atr cval
Expedite Prolecl(s): Child Care City Project Green Buildin
g Landmark Affordable Housing
For Staff Use Only
Building/Safety Permtt Specialist Coy Plaenina Civil Fngirw_adng E%NM-Admin Transpose o Mequ F C lml
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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