PMT14-03127 City of Menifee Permit No.: PMT14-03127
29714 HAUN RD,
Type: Residential Mechanical
MENIFEE, CA 92586 i
MENIFEE Date Issued: 11/25/2014
i
PERMIT
Site Address: 27605 CAMDEN WAY, MENIFEE, CA Parcel Number: 335-231-004
92586 Construction Cost: $6,900.00
Existing Use: Proposed Use:
Description of REPLACE 3.5 TON PACKAGE HVAC UNIT
Work:
Owner Contractor
STEVE BOROWSKI VENVEST BALLARD INC
27605 CAMDEN WAY 3030 MYERS STREET
MENIFEE, CA 92586 RIVERSIDE, CA 92503
Applicant Phone: 9512769744
JANE RECKTENWALD License Number: 878533
VENVEST BALLARD INC
3030 MYERS STREET
RIVERSIDE, CA 92503
Fee Description OQt Amount f$1
Fo'rce��.IIpO Sri f F �or�Bl�rrrer"" �., d n
Air Handling/Condensing Units SFR 1 133.00
L rrti ISM : . 7 p
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_edg_Permit_Templatespt 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 effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class C-_d<� License No.Q_1��`'-� who builds or improves thereon, and who contracts for the projects with a
Expire6 ,1-1 Signature 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 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 s' .//www.Ieolnfo.ca.aov/caIaw,htmI.
permit is issued.My workers'compensation insurance carrier and policy number are: (�' y_�1
roperty Owner or Authorize gen
Carrier � VLF � aJs- �e- U-1z S�F Date
Expires Policy#WY'GLSD7a-U_6P(0
❑ 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-
❑ I certify that in the performance of the work for which this permit is issued,I identified property for the inspection pu oses.
shall not employ any persons in any manner so as to become subject to the `L
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 orAuthorizedkAge Date
Code,I shall forthwith comply with those provisions.
�— City Business License#
Date;1�4� Applicant;
WARNING: FAILURE TO CURE 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, ❑YES 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 EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
INFORMATION GUIDE?
I hereby affirm that under the penalty of perjury there is a construction lending
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 0 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, 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 AYES 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 / /N.0 UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) HODEd ECOUS ION MAT5505t}E 5533'WG D 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole
compensation, will do ( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR RIZ T
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
• APPLICATION
Menifee I
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL 9k RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL R MECHANICAL
0 NEW 0 PLUMBING ORE-ROOF
APPLICATION NAME
DESCRIPTION OF WORK Replace 3'/z ton package HVAC unit
PROJECTADDRESS 27605 Camden Wa '-7
ASSESSOR'S PARCEL NUMBER 335-231-004 L07 —/7 TRACT „®- I�. &c,,,_,
OWNER NAME _Steve Borowski
ADDRESS 27fing Camden Way Sun City- CA 92586
PHONE 951-672-2571 EMAIL
APPLICANT NAME Jane RecktenWald
ADDRESS
PHONE 714-336-6159 EMAIL
CONTRACTOR'S NAME RI htime Air OWNERBUILDER7 OYES 4tNO
BUSINESS NAME
ADDRESS 3030 M ers St Riverside CA 92503
PHONE 951-276-9744 EMAIL
CONTRACTOR'S STATE LIC NUMBER 878533 LICENSE CLASSIFICATION C20
VALUATION$ 6,900.00 SQ FT L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION I CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE SMIP GREEN 36048
AMOUNT OCD PAIDAMOUNT 0,0 I-CASH O CHECK M OCREDIT CARO VISA/MC
PLAN CHECK FEES PAID AMOUNT p CASH 0 CHECK a O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED G YES 0 NO LICENSE NUMBER NOTARIZED LETTER C' YES 0 NO
City of Menifee Building&Safety Department 29714 Noun Rd. Menifee, CA 92586 951-672-6777
WWW.dtV0finenifee.us Inspection Request Line 9SI-246-6213
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