PMT14-02369 i
City of Menifee Permit No.: PMT14-02369
29714 HAUN RD. {
t El.,%> MENIFEE, CA 92586
Type: Residential Mechanical
MENIFEE Date Issued: 0910412014
PERMIT
Site Address: 30122 WESTLAKE DR, MENIFEE, CA Parcel Number: 364-022-026
92584 Construction Cost: $3,000.00
Existing Use: Proposed Use:
Description of REPLACE EVAPORATOR COIL&FURNACE
Work:
Owner Contractor
JOHN HODGE BEAR CREEK HEATING AND AIR CONDITIONING
30122 WESTLAKE DR INC
MENIFEE, CA 92584 24069 CHATENAY LANE
Applicant Phone: 9516002882
BARRY DUNGAN License Number: 779461
BEAR CREEK HEATING AND AIR CONDITIONING INC
24069 CHATENAY LANE
MURRIETA, CA 92562
Fee Description ON Amount 1$1
Forb�"�ed"�A'Sro�avv�ypeFurn ca eorBurne""'"'�"r "r� a�"� `_' "1 � � 14&`00
Air Handling/Condensing Units SFR 1 133.00
�B�n„ e itl,`s arrCe z���� prxi'� u ���� �-aas> 27Q4
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 staled,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 Code and my license is in full force and a ect.i Code:The Contractor's License Law does not apply to an owner of a property
License Class C ZQ Lic No. Z (, who builds or improves thereon, and who contracts for the projects with a
Expires Signal ur licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from licensure 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, I cannot legally sell a structure that I have
permit is issued.
Policy# built as an owner-building if it has not been constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law, Section 7044 of the
❑ 1 have and will maintain workers' compensation insurance, as required by Business and Professions Cade,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.Ieginfo.ca.Qov/caIaw.htmI.
permit is issued.My workers'compensation insurance carver and policy number are:
Carrier Property Owner or Authorized Agent Date
Expires Policy#
❑ 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 state laws relating to building
construction.I authorize re sentatives of this city or county to enter the above-
certify that in the performance of the work for which this permit is issued,I �d property for the in p tion purposes property for the in p tion purposes.
shall not employ any persons in any manner so as to become subject to the C�,�Jam•
workers'compensation laws of California, and agree that If I should.become
subject to the workers'compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those rowsions. Property Owner or Authkized Agent Nn D le
those
License#�^''�'715
Date; — �1`'\ ApplicanT�
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, 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, DYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A
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
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 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
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 ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) HOARSSECTION
3TI ON 25505RIAL 1';E 5533,AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole
oompensaton,will do( )all of or( ) porting of the work, and the structure is PROPWNER ORA TH GENTWNER ORA TH NT
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 OF 1V'illiNIFEE PLCKNo:
29714 Haun Road Date: Date:
Menifee, CA 92586
Phone: (951)672-6777 Amount: Amount:
Fax:(951)679-3843 0
Ck#: Ck#:
Building Combination Permit
To Be Completed By Applicant
Legal Description: ��1 Planning Case: F: L: Rt: R
Property Address: 1� Assessor's Parcel Number:
Project/Tenant Name Q Unit#: Floor#:
Name: 3�``� 1 `_ Phone Now. 6y`-7�SZ` Fax No.
Property Address: 3oz� z`-laS-���� Unit Number Zip Cod t>A
Owner
Email Address:
Name: ,`� Phone No.
Applicant lest Unit Number Zip `XXU D
Email Add r bs nt��r
1r K 1 Mil
Name: Phone No. Fax No.
Contractor Address: City State Zip Code
Contractor s t 'Hess c e Contractor's Cit Slate of Qalifornia License No. Classification: CZo
Number of Squares: 1ZS5J
Square Footage M
Description of Work: 2_ ``� �, r� Cost of
Applicant's Signature \ Date:
To Be CompletedSy.Gity3ta f Only_
Indicate As R-Received or N/A-go-rApplicable,
5 Completes sets of fully dimensioned,drawn to sale plans which include: f set of documents 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 8 Y x 11)
❑ ❑ Structural Calculations
Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan 1 ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition' Means/Methods
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 Indicate Indicate if YES or NO Indicate all Geo-tech.Haz.Zone
At Project Construction Sprinklered that apply: Coastal Zone
Completion:
Type(s): C of O YES or NO Noise Zone
uired Req ? 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.Vehicle Charger Landmark Seismic Retrofit specalCase,ulag.
ORmiatApproval
Expedite Projecl(s): Child Care City Project Green Building Landmark I Affordable Housing
For Staff Use Only
BuildinglSately I Permit Specialist ZI Cily Planning Civil Engineering EPWM-Admen I Transportation MgmL Renl Control
THANK YOU FOR HELPING US CREATE ABETTER COMMUNITY
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