PMT14-03400 City of Menifee Permit No.: PMT14-03400
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued:
12131/2014
PERMIT
Site Address: 28307 PASEO GRANDE, MENIFEE, CA Parcel Number: 337-410-057
92586 Construction Cost: $10,606.00
Existing Use: Proposed Use:
Description of REPLACE 60,000 BTU FURNACE, 3 TON 16 SEER A/C UNIT, COIL&DISCONNECT BOX
Work:
Owner Contractor
LULU REINICK VENVEST BALLARD INC
28307 PASEO GRANDE 3030 MYERS STREET
MENIFEE, CA 92586 RIVERSIDE, CA 92503
Applicant Phone: 9512769744
JANE RECKTENWALD VENVEST BALLARD INC License Number: 878533
3030 MYERS STREET
RIVERSIDE, CA 92503
Fee Description
O�lr Amount
Forced Alr or Gravity Type Furnaceor Burner 1 " 749NOQ(
Air Handling/Condensing Units SFR � " u133.00
Buildiwrte Permit Issuance .,_ ..a_, ems,
GREEN FEE y1 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
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 Codeand 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.�- License No. who builds or improves thereon, and who contracts for the projects with a
Expires P Signature--�'� licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from licensors 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 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. built as an owner-building if it has not been constructed in its entirety by licensed
Policy# 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^ 7
the following�Web site:http'dwww IeQInfo.ca.gov/caIaw.htrnl.
oovlcalaw html.
permit is issued.My workers'compensation insurance carrier and policy number are: `� -' -,-?,\- L
Property Owner or Aumo iz yant Date
Carrier �.o o 4(ax- 0.7CSk_.----- - - - __---------- - - - --- -_-- ----- -- -_ --------__
-----__ __ ------
Expires l- (- ku Policy#
❑ 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 urposes.
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 3t-If
subject to the workers'compensation provisions of Section 3700 of the Labor property Owner or Authoriz d ent Date
Code, I shall forthwith comply with those provisions..
City Business License# `--(� -LP�
Date; 0—Z11 H Applicant;
WARNING: FAILURE TO SECURE 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, AYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A
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 ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
y` O FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address
/xL 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 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 741
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 WO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE SECTION MATERIAL 25533�IA D 25534 CONCERNING
El I, as owner of the property, or my employees with wages as their sole
compensation, will do ( )all of or( ) porting of the work, and the structure is PROPERTY OWNER
UTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
BUILD BUILDING & SAFETYPERMIT/PLAN CHECK APPLICATION
`Menifee
DATE 12-31-2014 PERMIT/PLAN CHECK NUMBER 114�3
TYPE: O COMMERCIAL 4F RESIDENTIAL O MULTI-FAMILY 0 MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION O ALTERATION 0 DEMOLITION O ELECTRICAL 9 MECHANICAL
0 NEW G PLUMBING 0 RE-ROOF
APPLICATION NAME
DESCRIPTION OF WORK Replace 60,000 btu furnace, 3 ton 16 seer A/C unit, coil &
,lisconnect box
PROIECTADDRESs 28307 Paseo Grande Sun City, CA 92586
ASSESSOR'S PARCEL NUMBER 337-410-057 LOT _�_ TRACT ��p
PWNER NAMELulu Reinick
ADDRESS 28307 Paseo Grande Sun City, CA 92586
PHONE 951-602-5321 EMAIL
APPLICANTNAME Jaoe Reckte Wald
ADDRESS
PHONE 714-336-6159 EMAIL S att.net
CONTRACTOR'S NAME _E1ightimP Air OWNER BUILDER? O YES O NO
BUSINESS NAME
ADDRESS 3030 Myers St Riverside CA 92503
PHONE 951-276-9744 EMAIL
CONTRACTOR'S STATE LIC NUMBER 878533 LICENSE CLASSIFICATION C20
VALUATION$ 10 606.00 SO FT L SO FT
APPLICANT'S SIGNATURE DATE 19211-14
DEPARTMENT DISTRIBUTION CITY OF MENIFEE Bp$INESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE SMIP GREEN
WVgICE W PAIDAMOUNT
AMOUNT �1O O CASH 0 CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH G CHECK M O CREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES Q 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.Cityofinentfee.uS Inspection Request Line 951-246.6213
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