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PMT14-02923 City of Menifee Permit No.: PMT14-02923 29714 HAUN RD. L A> MENIFEE, CA 92586 Type: Residential Mechanical s xsbr.,�P MENIFEE Date Issued: 11/03/2014 PERMIT Site Address: 30219 WESTLAKE DR, MENIFEE, CA Parcel Number: 364-023-001 92584 Construction Cost: $8,435.00 Existing Use: Proposed Use: Description of REPLACE EXISTING HVAC SYSTEM 70K BTU FURNACE 3 TON COOL Work: Owner Contractor BRIAN ANDERSON BURGESONS HEATING AND AIR CONDITIONING 30219 WESTLAKE DR INC MENIFEE, CA 92584 P O BOX 7310 Applicant Phone: 9097933685 BRIAN ANDERSON License Number: 263871 BURGESONS HEATING AND AIR CONDITIONING INC P O BOX 7310 REDLANDS, CA Fee Description Oty 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 slated, 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. A 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_andmy license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property License Class 74> �License o',K �-J/ who builds or improves thereon, and who contracts for the projects with a Expires 3 3 i. t5 Signature licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLA I ❑ 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,//www.leginfo.ca.pov/calaw html. permit is issued.My workers'compensation insurance canter and policy number are: Carrier 416-51 Property Owner or Authonzed Agent Date Expires �.I Policy# a, LUt�JIj07J-Z1t_,Phone#To�7 [57z r S/ ❑ By my Signature below, I certify to each of the following: I am the property 04 Name of AgentC� 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 identifi d 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 r Owner A horized Agent Date Code,I shall forthwith comply with those prov' ions. City Business License# Date; Applicant; WARNING: FAILURE TO S U WORKERS' HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE IS UNL L, 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 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 *0 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 AYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address 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 AYES 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, -60 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 UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL ikEPOR1 ING. compensation,will re ( )all of or( ) porting of the work,and the structure; P�WNER OR AUTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). CITY OF MENIFEE PLCK No: Permit Ngi Q 29714 Haun Road Date: Date: Menifee, CA 92586 / Phone: (951)672-6777 Amount Amount Fax:(951)679-3843 Ck#: Clot: Building Combination Permit To Be Completed By Applicant Legal Description: a — Planning Case'. F: L Property Address: 1 i i 1 Assessor's Parcel Number. -3(oq 'oa3-Oo Project/Tenant Name: Unit N: Floor .: Name: 1 o.P Fax No, Prop O.vn ,yer y Atldress: d Z Unit Number Zip Code Email Address: Name: J O Ph o N 2- VEd Applicant Address: 2� / Unit Number e Email Address: � C)1t Y So S Name: Phgqne No. Fax No. �UI' CSon'S H�- � i4/(: J--nC. 70 - 7'7 -3f. � Contractor Address:UID Tenne55ee + Ciry��'��ds St3)e� Zip y onrractor'a City s b o- Contractor's City State o,[LC I fomgi Lin.... ii ens.No- Classification: p Z3 Number of Squares: Square Footage G Description of N/or • ,/ 0410a ost of Work:$ Applicant's n Y � Date: o Be C p eted By Ciry ff Only - - Indicate R- N ceived or 'A-Not Applicable 3 Co totes sets of fully dimepi onad,drawn to sale plans wh!ch include: 1 set of doccmee�s wiicn!rdutl=_ ❑ Title.Sheet ❑ Elevations ❑ Electrical Plan ❑ Gan Tech/Soils Report(on cd only) ❑ Plat/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 V,x 11) [I Structural Calculations ❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Single Line 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/hlathods Work Type: Repair' Retrofit* Reuisicn to Existing.Permit' Required? YES NO Proposed Building Use(s)- Existing Building Use(s). 9 Buildings: #Units: IT Stories Will the Building Have a Basement? Y of N Bldg. Code Occupancy Group Indic ata Indicate if Indicate allHcGoasta[Zone eo-tech.Haz.Zone At Project :ipdnklered YES or NO Completion: Construction that apply: Type(,)" C Of o YES or NO Noise Zone Require, Y Listed on Historic Resources Inventor/ CITY PLAPINING STAFF ONLY APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator Fee Exampt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit s°e^a lr � O:as b:ficial Accmval Expedite PrajecP(s). Child Care City Project Green Building Landmark I Affor_abie Housing For Staff Use Only - 91.1dl1.7J.5elel P,li Sped.!": City P:anni,g C!vd Er9in=_ern3 I F`*M-Admin Tansoorta ling Al d:nt Racl Con'roi THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY n A n w an D v D_ n O m m G — 3 N m as O n' w x, !? o m N a 3 O ° 3 3 - •di. n J y 7 oni tl0 N y 0 O r T O O oa n v+ D 3 3 O o Y 1p 3 W D N v� z < A D n � o _M to Z N N O' a < O < O ^ p d 0 r m fTD vOi 3 n 3 d A Ga p=q D » 3 C N n 7 1 D 3 n m .: O D O F+ � 'O Z— O A A oo M a Q m N m m N a O M O F+ £ Z O 0 m ? m T N Z T O O W O of0i 09 > > > c9 ° m m a O 3 CD Y O a O N N C d 3 w a d m !p O — z o m = O v00 m a T + m N N G D_ N = O O O � AvAi oa D D O' W < J N N N d F+ m 9 O O N m ^ ^ ym� r o ^ m F A •� O; .r ¢ p p N A p N N d �: M rde T w ? m � � in '^ o ko p 3 3 .mdr 3 IUD O n " m CL D ^I O d d T A A N no O ID d n in F' � .< D 3 m a x Z o o a m y d 3 w G r oa V PavAi wxp try ^: Z v N fe _ ma y ain oa to - N =� 'ooa ,� ° n 3 m m W a r c ' o p m m O Z O j O 3 S D 00 OOa• 0- ET a w J ¢ m ID > > N o In c. n w £ t w Ln n m � O 3 £ d m 3 Q D m j 3 i = P°�O o a-• a0i o F+ fD 3 •• W m S N O 3 > = �a' M. m < 3w D +S n 'i o £ � a o o n •G O O R x m a o O A o a C N R N m m W CT C m .O 09 .D O v� O C p N no N J m Ch 3 ^p D 3 o D N p n s m S a 4 0 o 4 m d m °" m w £ N 3 !D w Ch a m t° 3 N m m vMi x p w m m V F+ p a . n 0 a' N p W C f0 3 0 lD _ N O d n Q w1 2 d A N V < C ~ N s a m O - o x N m n L1 C A 2 N J � O T O 9 W G d F C � N ton D A '" A rn m 1 M T m Z vi y fD ? 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