PMT14-02191 V
E
1
City of Menifee Permit No.: PMT14-02191
29714 HAUN RD. Type: Residential Mechanical
i
�f-�. %3?` MENIFEE, CA 92586
MENIFEE Date Issued: 08/19/2014
PERMIT
Site Address: 28545 COUNTRY ROSE LN, MENIFEE, Parcel Number: 372-230-015
CA 92584 Construction Cost: $11,000.00 '..
Existing Use: Proposed Use:
Description of REPLACE HVAC 4-TON A/C AND 90,000 BTU FURNACE
Work:
Owner Contractor
GLENN RICHESON COOL AIR SOLUTIONS INC
28545 COUNTRY ROSE LANE 41162 SANDALWOOD CIR STE 101
MENIFEE, CA 92584 MURRI 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 Oty Amount
Air Handling/Condensing Units SFR 1 133.00
GREEN FEE 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 Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that Iam 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 CI s License N 7 `O`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 RA 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.
# 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
p, 7 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:http�//www.leciinfo.ca.govicalaw.html.
permit is issued.My work/ers'compensation Insurance carrier and policy number are:
Carrier Tl Pl' A9� Property Owner or Authorized Agent Date
Expires 5�/xS Policy# 1&0001,514#41
❑ 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. 1 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 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 - _
subject to the workers'compensation provisions;of,Section 3700 Nee Labor Pr
w e o uthorized Agent
Code, I shall forthwithcomply with those provisj6 st. _ ' \
—S l' l City Business License#
Date; (1 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, ❑YES OCCUPANT HANDLEA 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 DYES 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
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 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, 0 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 p.N&--- 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 I'tEPORI'ING._---
compensation, will do ( )all of or( ) porting of the work, and the structure is PROPE TY O: R ORAI�T RIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's Slate 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 `vl` NiENIFEE-' PLCK No:. Permit No:
City of Menifee o�yq�
219714 oar: *MLA-
Haan Road Building & Safety Dep --''
11 ,
a1�1 �►y f
Phone: (951 )672-0777 AUG 19 2014 IAmcun;:.._. ._-i^maun;: � I
Fax:(951 )679-3643 kxC k 3
10
Received
To Be Completed By Applicant
J-�.,�r;Ne.�r. cnnirg Cass. F: 1
L Rt. R
Propo,,ty Addruss: Asseasu,'s Parcel Number.
45 Ca,�r lase .� 3�2 2 30 o/S
Project/Tenant Name: Unit#: Floor#:
Name: Phone o Fax No.
Property Owner Address: $4it-o/7at- -1 Unit Number Zip Codri.,
aceHEmail Address:
Name: d/�o�tr I 1 1�U Phone No
atle /1/ `15L (c�fa 2LcCoS F � (a7(n 2[o�D
Applicant Address- ( 1 t Unit N er Zip Code
-� i'Ze2J`�Q/9(�a, tn",�vDrJ G�' ---�{�( �a� 5Z5Cc2
Email Address A gpCoo1C,;,Srk in 0
more
Name_�f tt}}qq�� jjJJ
t�pl Air Solt DYis PYJeJ-n(n7�n 2CDCn5 F $N�-{q e�C
Contractor Address 3/6Z ^ dA Awcod ^ - /0! City 1 _ Stab r Zip C0'4e:5 Z
13 �p ) 9+a C7fPl�'J(1 _�s'�J _ `� S�
'ontrac or ^Ry_ .usine ensE No. Gnat-ec[u. s Gif S` ie of Cali'ornla L Classification
icense No- Cl :
03 3 d 2C7
Number of Square
Square Footage Af+/3
Dessiption of bb'ork. ./�G Cost of Work.S //lnoo
/ r cill
Applicants Signature
Dater �!y
-` --- - To Be.Completed By City Staff:Only� -
Indicate As R-Received or N/A-Not Applicable
5 Completes sets of fully dimensioned.drawn to said plans which include: t se,of docurneris which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Goo Tech/Soils Report(on ed only)
❑ Plot[Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8'/,x 11)
❑ Foundation Plan El 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" Meanslfarenods
"'Jerk Type: Repair' Retrofit' Revision to Existing rmil' Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
# Buildings: #Units: #Stones: Will the Building Have Basement?
Y of N
Bldg- Code Occupancy Group Indicate Indcate if YES or NO Indicate all Geo-tech. pi
Zone
At Project Construction Sprini<Iered that apply: Coastal Zone
Completion: Type(s): C Of O Noise Zone
R�nuired% YES or NO
Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm- Planning Comm. Zoning Administrate,
Fee Exempt. City Projc>ct Elec.Vehicle Charger Landmark Seismic Retroff ,peuN uric Milk,
Expedite Project(s): FChild Care City Project. Green Building Landmark Affordable Housing
For Staff Use Only
iF-
Ruildlno/Safe,y PPrmn Sa^riaiist City Poanbinn Civil Engin=acing EPlNF4-Admin gran;periation"^,^�;. -F.cnt C.-nual
-HANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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