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PMT15-00886 f City of Menifee Permit No.: PMTIS-00886 29714 HAUN RD. MENIFEE, CA 92586 Type: Residential Mechanical MENIFEE Date Issued: I 04/OS/2015 i y PERMIT i Site Address: 27820 GRAND AVE, MENIFEE, CA 92585 Parcel Number: 333-242-005 Construction Cost: $17,382.00 Existing Use: Proposed Use: Description of REPLACE 4 TON A/C, COIL 90,000 BTU FURNACE&6 DUCTS Work: Owner Contractor KEVIN FLYNN W C HEATING&AIR CONDITIONING INC 27820 GRAND AVE 41085 GOLDEN GATE CIR MENIFEE, CA 92585 MURRIETA, CA 92562 Applicant Phone: 951 STEVEN SCHNIERER License Number: 779604 W C HEATING&AIR CONDITIONING INC 41357 DATE ST MURRIETA, CA 92562 Fee Description Y. Amount I$) Fdreed Air or Graves Type Furnace or Burner 1 149 00 Air Handling/Condensing Units SFR - u ,..1� �r 133.00 vBwldmgPermitissuance 1' 2700 ., 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 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 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 CZo License No. =7GI(oby who builds or improves thereon, and who contracts for the projects with a Expires 613d I Signature [-, _r v 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 ❑ 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 � have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is on 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http'llwww lepinfo ra povlcalaw html. permit is issued.My workers'compensation insurance carrier and policy number are: Property caner or uthorized Agent Date Carrier��l�1�c U1.c�er t,�i��exs Expires I I . � Ito Policy# A'Tw On 3 A-414 OI �y my Signature below, I certify to each of the following: I am the properly 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 _Z_ 4 8IS subject to the workers'compensation provisions of Section 3700 of the Labor Property Owner or Authorized Agent Date y Code,I shall forthwith comply with those provisions. ,�� City Business License Date;=J 8115 Applicant; WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION r 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 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 ALO 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 e OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION Lender's Nam - � ' FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address /�^0 DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDE LINES OWNER BUILDER DECLARATIONS ` PRINT NAME: I hereby affirm under penalty of perjury that I am exempt from the Contractor's ��e'��'�-�SLI.v��cr eY' 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 I HAVE READ THE HAZARDOUS MATERIAL provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or ES INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from licensure and the basis for the alleged exemption. Any a'— ` 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 ($500).) CODE SECTION IONMAT 25505RIALf�EP533Okt AND 25534 CONCERNING HAZAND❑ I, as owner of the property, or my employees with wages as their sole compensation,will do( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; C`_— adz___ The Contractor's State License Law does not apply to an owner of a property X •�""^'�� who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion,the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). APPLICATION& SAFETY PERMIT/PLAN CHECK *Menifee DATE L.4 IJ PERMIT/PLAN CHECK NUMBER 5��J1J0� TYPE: C)COMMERCIAL k ESIDENTIAL CI MULTI-FAMILY 0 MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL MECHANICAL :u NEW CI PLUMBING ) RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK c \cqc c 'A kov c- C c10 000 B1 V FQrr%C�C.CC lb roc 5 PROJECTADDRESS Z-7220 GCC,\, vz ASSESSOR'S PARCEL ',NUMBER 333 ,P4_�-V05 LOT JA TRACT 1 1�3o� .7 OWNER NAME htV�V\ hr ADDRESS 2'1420 c. . r eyniker- CA QZ52S PHONE 951- Z.35- c1SF1 EMAIL APPLICANT NAME ADDRESS 3122� Lc_ 1�-.a i4 1l2We skk 4--c_Vi Lk CA 01 13C;L PHONE CJSI-(,00 0"7LY_'> EMAIL CONTRACTOR'S NAME l e_c Jivr S A C OWNER BUILDER? OYES,AD BUSINESS NAME �{ �Q�s der. rj6{e (-; `-;��F CQ Q 2,G L ADDRESS PHONE g,5j-(cC0-(D_1C ) ,�,,"" EMAIL CONTRACTOR'S STATE LIC NUMBER -7-7ci" LICENSE CLASSIFICATION G2LO VALUATION$ 17, 3512..cyo SO FT L SO FT APPLICANT'S SIGNATURE Sid u2-- DATE <-4121 6 OTYSTAFFUSEONLY DEPARTMENT DISTRIBUTION a CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAIDAMOUNT AMOUNT to A% H ""CHECK# CCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT () CASH ""CHECK# CREDITCARD VISA/MC - OWNER BUILDER VERIFIED C%YES C% NO DLNUMBER NOTARIZED LETTER C, YES '% NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 § n > \ \ 7 z � ® { \ . / j , § $ f § §_ _ _ , - 3 | (\ I _ z \ } ° ( ; \ - } ) \ j : - \ ` 0 / { § MD 0 ` [ } I > 3 _ , ( ° / ® m ; Z Z 0 ƒ \ - 0 ± { [} Z2 m CL | D7 -3 0 M _ . m 0 / _ ( ? 7- co 2 § « ( - < - : ` ` CD\ } } \ 30 . 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