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PMT14-02190 City of Menifee Permit No.: PMT14-02190 29714 HAUN RD. Type: Residential Mechanical a' r-lS.". 1. MENIFEE, CA 92686 e�A44'." MENIFEE Date Issued: 0 811 912 01 4 i i PERMIT Site Address: 28679 NORTH PORT LN, MENIFEE, CA Parcel Number: 364-146-029 92584 Construction Cost: $9,000.00 Existing Use: Proposed Use: Description of REPLACE HVAC 2-TON A/C AND 70,000 BTU FURNACE Work: Owner Contractor MARK AMBROSE&LESLIE CHRISTNER COOL AIR SOLUTIONS INC 28679 NORTH PORT LANE 41162 SANDALWOOD CIR STE 101 MENIFEE, CA 92584 MURRIETA, CA 92562 Applicant Phone: 9516762665 MORIAH NEUGEBAUER License Number: 874502 COOL AIR SOLUTIONS INC 41162 SANDALWOOD CIR STE 101 MURRIETA, CA 92562 Fee Description qty Amount is Force Ai oaGr> y eeF ` eor�Burr�e'r �� � tn ' 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 building 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_Bidg_Permit_Template.rpt Page 1 of 1 i i City Of Menif@e 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 s License N '7 ` `L who builds or improves thereon, and who contracts for the projects with a Expires Signature licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION D L RA ON ❑ I am exempt from licensors under the Contractors'State License Law for the ❑ 1 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, cannot legally sell a structure that 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 E/rhave and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is secVon 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http://www,leginfo.ca.gov/calaw,html. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier �QYt� - Property Owner or Authorized Agent Date Expires��/�J� Policy# (v 000/,3/G 1H1 ❑ By my Signature below, I certify to each of the following: I am the property Name of Agent- Phone# 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 slate laws relating to building construction. I a0prize representatives of this city or county to enter the above- ❑ I certify that in the performance ofthe work for which this permit is issued,I identified propertyf r the inspection purposes. shall not employ any persons in any manner so as to become subject to the workers' compensation laws of California, and agree that if I.should become - 9 subject to the workers'compensation provisions Section 3700 Y�IIllyyye Labor Code, I shall forthwith comply with those pro is . Propert w o uthorized Agent D to City Business License# r 33 Date; Applicant; - _ WARNING: FAILURE TO S CURE 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, EYES 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 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 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 EYES 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 EYES 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 (1.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 F}EPORYING. compensation, will do ( ) all of or ( ) porting of the work, and the structure is PROPE TY O NER OF�AAU HORIZED AGENT not intended or offered for sale.(Section 7044, Business and Professions Code; 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). IT Y OF MENIFEE PLCK No: Permit No: 297 i f�aUI I ROd City of Menifee e. ------ q"vNm .-C iVl.".nitee, U'A 9'-"✓� Building & Safety Dept. _ -......___.._.__. .. Ala 1 Ill. I Phone: (95'I )672-6777 AUG 119 2014 Amount Am a 40 Fax:(951 )679-3843 Ck# Ck#: 9 , lved - -r - N -.,.Frn t+.�^ I i To Be Completed By Applicant egal Do„adptle aviing Csoc. P. L Rl. P Property Address: ^ Assrsaor's Parcel Number: 2frlQ'7 9 . a FJ 3 ,g6OZ ProjecVTenant Name: Unit#: Floor#: Name: / / / Phone Np,_ ^�Z Fax No. Pro �e e.-� SdS Ownnerty rili/ i(C-Address: Unit Number Zip Code SAY Email Address: Name: „/o/'IOLI'� /Vt e PhQne�-o�t7f0'a�O�Os F7-�/-[o7CO2CDlo�D Applicant Address-4 1 1(&Z So-,,Uai 1Aiood ._ r- 4�lot Un 2� it N,� er Zip Code e yr/iP}A s �2 Email Address: / // /Y70/vAh �GDO�GsISOJi7�ONS.GObLt_. Name/1 1 ��c, }� —V� p -y� f� C�1 AAr :3OI�DYts P7 /-o�p/UJ2�D�� F jN _Z&( Contractor Address=-4116Z dA1u-)d >J C-;Y f 101 City •-1 Stag Zip.Co,{iesG 2 E yr/aelc0. (�1 _ e6e Cori[ractor's City Business License No. Gonirnctor's Cit Sate or Gelifornes License Inc. Classification r � � - ic- Number of Squares Square Footage Description of Work: i!�/ /( ZO eoCost of Work:S '00o _ Applicant's Signature//! t7/iJ tl�l� - - - To Be"Completed;By City Staff Only Indicate As R-Received or N/A-Not Applicable 5 Completes sets of fully dimensioned,crown to sale plans which include: t set of documents which include ❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Garr Tech/Soils Report(on cd only) ❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8'G 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` Additarl Means/Methods Work type: Repair' Retrofit' Revision to Existing Pefrot' 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 Groub Indicate Indicate if YES cr NO IndicaL=all Geo-tenh. Haz.Zone At Project Construction Sprinklered that apply: Coastal Zone Completion: Type(s): C.cf o Noise Zone Required? YES or NO Listed on Historic Resources Inventory Cl FY PLANNING STAFF ONLY APPROVALS: Costal Commiss Arch. Review Board Landmark Comm Planning Comm Zoning Administrator Fee Exempt City Project Eoc. Vehicle Charger Landmark Seismic Retrofit Speela:casc.BIJ, ORiaal Anpmvel Expedite Project(s): Child Care City Project Green Building Landmark AHnmable Housing For Staff Use Only i Putldin JSa(ety ) Permit Speclahst ( CityPlanrvne Qvil Fngirwenan EPWnd-Atlmm I Tmncpertahan Momt. 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