PMT14-02374 1
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City of Menifee Permit No.: PMT14-02374
_ 29714 HAUN RD. !
Type: Residential Mechanical
MENIFEE, CA 92586
MENIFEE Date Issued: 0 9/0412 01 4
PERMIT
Site Address: 28270 STILLWATER LN, MENIFEE, CA Parcel Number: 364-053-009
92584 Construction Cost: $10,490.00
Existing Use: Proposed Use:
Description of REPLACE HVAC 3 TON A/C&45,000 BTU FAU
Work:
Owner Contractor
MATTHEW REINHOLD COOL AIR SOLUTIONS INC
28270 STILLWATER DR 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 ON Amount
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 Bldg Permit Template.rpt Page 1 of 1
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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 I
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 f rce and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Cie s - License No. !�2- who builds or improves thereon, and who contracts for the projects with a
Expires. O S Signature
P - �- licensed contractor(s)pursuant to the Contractors State License Law),
WORKERS'COMPENSATION CL RATION
❑ 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 must have resided for at least one year prior to completion of
Section 3 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
Policpermy
issued. built as an owner-building if it has not been constructed in its entirety by licensed
y 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 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 legiofo ca cov/calaw html.
permit Is issued.My workers'co pensation insurance carrier and policy number are:
q,�tQ Property Owner or Authorized gent Date
Carrier 7
Expires—r �`' Policy# /6nd0/31CP/k/
Name of Agent Phone# ❑ By my Signature below, 1 certify to each of the following: I am the property
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 unty ordinances and state laws relating to building
construction. authorize y6 espit lives of this city or county to enter the above-
❑ I certify that in the performance of the work for which this permit is issued,I identified property for t-e i spectior{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 of the Labor property Ow er or thorized Agent Da__
Code,I shall forthwith comply with those provisions.
te
City Business License
Date; �R' �pplcan ; '�
WARNING: FAILURE S CURE WORKERS'COMPENSATION COVERAGE IS -UIJLAWFUL, AND SHALL HAZARDOUS MATERIAL DECLARATION
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, OYES 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
Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
ONO 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 OYES 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 OYES 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 ($500).) CODE, SEC 0N255 505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOU MATEPtAL F'EPORYING.
compensation,will do ( ) all of or( ) porting of the work, and the structure is PROPER Y OW R OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044, Business and Professions Code; -;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY t3F AV ENIIFEE PLCK No . 14-� lq
20714 Hauf1 Road -- `�
O1 1 1
Phone: (951)672-6777 nmou. IAmount
00
Fax;(951)679-3843 3
Ck# .gCk= `f'f�3
ofnn, `". 'r1 „t ' r _ r _
To Be Completed By Applicant
Lpgal Descripncn: � �,� � �{� Planniny Ca.;u.
i fopul ty Address. W Asoeasur e Parcel Numbe.
28270 S1il1wq�r/' br 3lv�}OS3p0`j
ProjectlTenant Name: Unit# Floor#:
Name. Phone No. Fax No.
A Wd R51 �5"1-03$S
Property Address: Unit Number Zip CodEja
Owner 50-4te—
Email Addre{ss: �Ig
Name: �/lo/Y'" �l/Q.,YJ evv" Pn�St- ,1lv"2(o{os F`�/-107fo•2Coty®
Applicant Address ''1 Unit N r Zip Code
41l�25rvrdel e xaporJt �',r °tom' Ic'�! ;1_je ?Z.5C
Email Address:
/Y70/`1Ckh �C0o,4'�/'.SO�i77Y0%S•t O b1t�
Name:CCo Sf rr��o N
oI dt/ DI,r),Ons Py5/-°lv7fn2Co(o5 F}sN7-(n7fc'ZCo(.0
Contactor Address: ,/ t n , ,®i Clty •_1 _ +SI'6
Zip'o�:5 2-
contractor ' •-+�T >s L censE No. fon[rectur's C�aI S>.ate o�fI ali(ornia License No. ssi5cation.�
Number of Squares'. 5JO2
srluare Foolao,
Description of b?tork. t+VAc, 3 Jon AC 9- 45,000bjv efa.., Cost of Work:S i�t"YQ�_
Applicant's Signature -
_
-� - To BeCompleted By„City Staff Only -
Indicate As R-Received or N/A-Not Applicable
5 Completes sets of fully dimensioned,drawn to sale plans which Include: t set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 81G x 11)
❑ Structural Calculations
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan
❑ Single Linz diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan 8 Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration* Addition` Means/Memods
Work rype. Repair' Retrofit" kevision to Existing Permit' Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have a BasemenO
Y of N
Bidp. Corte Occupancv Grouo Indicate if Indicate all Gan-tech. Haz Znne
Indicate YES or NO
At Project Construction Sprinklered that apply: Coastal Zone
Completion: Type(s): Coto Noise Zone
RegviredZ YES or NO
Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commis Arch. Review Board Landmark Comm Planning Cnmm. Zonino Administrator
Fee Exempt. City Project Elec.Vehicle Charger Landmark Seismic Retrofit Special Case,"lug.
OHrial Ap ,,vrl
Expewte Project(# Child Care City Project Green Building Landmark I Affnrrladle Housing
For Staff Use Only
Pwldinn/Safely PermR Speorelat CIIv Plannmc Owl Emmnaynaq EP%VIA-Admm Tm sport.I m mg" R '-
'HANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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