PMT14-02835 City of Menifee Permit No.: PMT14-02835
MENIFEE,
EE, C 92 Type: Residential Mechanical
✓�. MENIFEE, CA 92586
s ava s�i�wn MENIFEE Date Issued: 1 0/2 312 01 4
PERMIT
Site Address: 28382 PASEO GRANDE DR, MENIFEE, Parcel Number: 337-410-068
CA Construction Cost: $9,500.00
Existing Use: Proposed Use:
Description of HVAC C/O, REPLACE HEAT PUMP 2.5 TON, REPLACE AIR HANDLER 70,000 BTU
Work:
Owner Contractor
JULIA DYER A PLUS GENERAL CONTRACTORS INC
28382 PASEO GRANDE DRIVE 11330 KNOTT STREET
MENIFEE, CA 92586 GARDEN GROVE, CA 92841
Applicant Phone: 7149010500
ROY DOMINGUEZ License Number: 763154
A PLUS GENERAL CONTRACTORS INC
11330 KNOTT STREET
GARDEN GROVE, CA 92841
Fee Description QQtr Amount is
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 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 Cod Q4nyy li se is in fulLfor a and effect, Code:The Contractor's License Law does not apply to an owner of a property
License Class —01 `1aZense No. (� III who builds or improves thereon, and who contracts for the projects with a
Expireslf-31 1,J Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECN
❑ lam 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
I 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'/1www.Ieoinfo.ca.gov/calaw.html.__
permit is issued.My workers'com/ppensation insurance carrier and policy number are:
Carrier S�q�'/L �(lti Property Owner or Authorized Agent Date
Expires ! �� �� Policy# 7/_&0 6W /
❑ 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 representatives of this city or county to enter the above-
0 1 certify that in the performance of the work for which this permit is issued,I identified property for 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 of the Labor property wrier or Authorized A nt Date
Code,I shall forthwith comply with those provisions. q
�
Q _ City Business License
Date; 0
-1 r7` Applicant;
WARNING: FAILURE T SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE S 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, OYES 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 ONO 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
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 OYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable Item(s) (Section 7031.5. Business and Professions Cade: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, ONO 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 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($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPOR1 ING.
compensation,will do( )all of or( ) porting of the work, and the structure is PROPE TY OWNER ORAUTHORIZE AGEN
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale. If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
"kCAT OF MENIFEE PLCKNo: Permit N
`o:
29714 Haun Road City of Menifee Date: Date:
Menifee, CA 92586 Ruildinq & Safety Dept. Q _ Z
Phone: (951)672-6777 Amount: Amount: i
Fax:(951)679-3843 OCT 23 2014 ck4: Ck#Zl0
�� za.�.
Building Combination P6�pived i
To Be Completed By Applicant
Legal Description: Planning Case: F: L: Rt: R
Pro ert Addre s: Assessor's Parcel Number.
3 — Ip/�. .9 7 - �L O - d(a r
roject/Tenant Name: Unit#: Floor#:
Name: Z to Vho2 Ng. — Fax No.
PropertyAddress: /�n ^^ , /D ummbber P-a Zip Code
Owner (o '�'U /�.
Email Address.
Name: Phone No. Fax No.
Applicant Address: Unit Number Zip Code
Email Address:
ame / N �`n �0 h�� / \ Fax No.
Contractor A r Vim, St a Zip qsi� 1
OL G
Contractor's iBsirless3cense o. Contractor's 5 to F alifornia License No. Classifcatiogl
��
Number of Squares:
Square Footage
Descripti 1 r : S.�Ts r 0 /n . kYL4AND`QQ Cost of Worlc$
Applicant's S' nature w h 4{�, 674 70/0 Oate:It /
To Be Completed 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: 1 set of documents which Include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on ad only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on B'/,x 11)
❑ ❑ El 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 ` ❑ 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 that
all Geo-tech.Haz.Zone
At Project Construction Sprinklered 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 Eloc,Vehicle Charger Landmark Seismic Retrofit special case.emy
OrflclallA oroval
Expedite Rol cl(s): Child Care City Project Green Building Landmark AHordahle Housing
For Staff Use Only
Building/Safety Permit Specialist Lily Planning Civil Engineering EPWM-Admin Transportation Mgmt. Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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