PMT14-02962 City of Menifee Permit No.: PMT14-02962
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 11/10/2014
PERMIT
Site Address: 29415 COTTAGE CT, MENIFEE, CA Parcel Number: 333-501-016
92584 Construction Cost: $4,136.00
Existing Use: Proposed Use:
Description of REPLACE 4 TON 13 SEER A/C UNIT ON SIDE YARD
Work:
Owner Contractor
VASILEOS KORDAKIS VENVEST BALLARD INC
29415 COTTAGE CT 3030 MYERS STREET
MENIFEE, CA 92584 RIVERSIDE, CA 92503
Applicant Phone: 9512769744
JANE RECKTENWALD License Number: 878533
VENVEST BALLARD INC
3030 MYERS STREET
RIVERSIDE, CA 92503
Fee Description ,QtV Amount($1
Building Permit Issuance 1 27.00
$161.00
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
it
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 effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class C2-6 License No. `6_jSSc�3 j who builds or improves thereon, and who contracts for the projects with a
Expires 3�'W Signature � licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ 1 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 must have resided for at least one year prior to completion of
Section 3ssu of the Labor Code, for the performance of work for which this improvements covered b this permit, I cannot legally sell a structure that I have
permit is issued. P Y P g Y
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 Code,is IIoe 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 follawla9Jp( te''fttgx://www leoinfo ca aovlcalaw html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carries` VS 1G a� +k" o_ well k" Property Owner or Authoriz d A e Date
Expires Policy# U�.)V�`�03a-(Q(o(,C�L
Name of Agent Phone# ❑ By my Signature below, I 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 county ordinances and state laws relating to building
construction. I authorize 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 for the insiney t o 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 Owner or Authors d A t
Code,I shall forthwith comply with those provisions. P rtY Date
Date; Applicant;
City Business License#
WARNING: FAILURE TO SEC E 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 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
❑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 DYES 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 f EPORYING,
compensation, will do( ) all of or ( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's Stale 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-
Bullder will have the burden of proving that it was not built or Improved for the
nurnnce of sAW
I
CI Tt'Y IOF MENIFIEE
PLCK No: Perot N
29714 Haun Road Dale Del ba
: e:
Menifee, CA 92586 11 d
Phone: (951)672-6777 Amount
ml:I '
Fax:(951)679-3843 ck Iris:
Building Combination Permit G
-M st its,% To Be Completed By Applicant
Pea] tie ` n 13 seer A/C unit in back yard Planning Case:
Property Address; Assessor's Parcel Number.
333-501-016
Pro)etllTenanl Name: Unit l Floor M
Name: Vasileos Kordakis P �-%6-8138 FmNo.
Properly Address:
Owner 2 41 ode Cottage Crt Unit Number C
Small Address:
Name: Phone No. Fax No.
Jane Recktenwald
Applicant Addmss: Unit Number
rW Code
Email Address:
Name: Phone No. - 744 LFaxo.ConeaGor Addmss:303Q M erS St CfscaZip Cade !
omraefws ry usmesa censa o. ide
Contraclor'a GIY SWIG of Callfomfa Dense No. Cleselfxellan:
Nvmber o!Squares:
(120
Square Footage
Description arwork: Replace 4 ton 13 A/C nit on side and cast of wadr:s 4136.00
Applicants Signature Date:
11 10-2014
Be-Complet7d By,Cty staff:Oril
indicate As R-Received or N/A-Not Applicctol
5 Complalos sets of fully dimeniened,drawn to sale plans which include: t at of documents which include
❑ The Sheet ❑ Elevations ❑ Electrical Plan
❑ Gee TeeWSoils Report(on cd only)
❑ Plot I Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Tide 24 Energy(on a y,x ti)
❑
❑ Plumbing Plan ❑ Structural Calculations Foundation Plan ❑ Cross Section ❑ Single Line diagram for else.services over 400 AMP
❑ Floor Plan ❑ Stricture!Fishing Plan It Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate I lNew,Construction Alteration' AddlOon' Meanslhlelhnds
Work Typo:DRepair' Retrofit' Revisknlo Exisfing Permit' Requtred4 YES NO
Proposed Building Use(s): Existing Building Use(s):
g Buildings: g Units: k Stories: Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indlcoto it YES or NO Indicate all Gee-lees.Hoz.Zone
AI Project Indicate Sprinktarml
Completion: Construction that apply: Coastal Zone
Type(s): C Of O YES or NO Noise Zone
Roquired? Used an Historic Resources Inventory
CITY PLANNING STAFF DNLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Admrnisirator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic RelfoM Sp0011 case: leg
O'po.l Aomovwl
Expedite Project(s): Child Care City Project Green Building Landmark I Affwdab!e Housing
For Start Use Only
adiding15a!ol1 I Perini+Spa[infi;t Cry Henning Gnl Enninetnnn I EP'rVAI.A tm'n r..�
THANK YOU FOP.HELPING US CREATE A BETTER COMMUNITY
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