PMT15-01208 City of Menifee Permit No.: PMT16-01208
29714 HAUN RD. Type. Residential Mechanical i
"�GCiIEt-% MENIFEE, CA 92586
MENIFEE Date Issued: 0 610 8/2 01 5
PERMIT
Site Address: 30195 WESTLAKE DR, MENIFEE, CA Parcel Number: 364-023-004
92584 Construction Cost: $2,800.00
Existing Use: Proposed Use:
Description of REPLACE A/C CONDENSER&COIL
Work:
Owner Contractor
CLIFFORD&KATIE RUSSELL BEAR CREEK HEATING AND AIR CONDITIONING
301985 WESTLAKE DR INC
MENIFEE, CA 92584 24069 CHATENAY LANE
Applicant Phone: 9516002882
VALERIE DUNGAN License Number: 779461
BEAR CREEK HEATING AND AIR CONDITIONING INC
24069 CHATENAY LANE
MURRIETA, CA 92562
Fee Description Qtv Amount isl
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
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 nd effect. Code:The Contractor's License Law does not apply to an owner of a property
License Clas )-0 License No i / who builds or improves thereon, and who contracts for the projects with a
Expires 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
❑ 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
a'I lion 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto'//www.Ieglnfo.ca.QovJcaIaw.html.
permit is Issued.My workers'compen§ Lion insurance carrier and policy number are:
Carrier `��.(e. U` VIO c/ Property Owner or Authorized Agent Date
Expires � Policy# g q/
2 1 uIR1/� �A �q ,t�J.7_e,__"f By my Signature below, I certify to each of the following: I am the property
Name of Agent ` ," (Phone# o ner 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 identifed;prop�rty 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 property caner or Auth rized Agent Daie
Code,I shal fort with comply with those prov_isio .
City Business License# 4a
Date; d� Applicant;
WARNING: FAILURE TO SECUR 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 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 11
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 ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address 0 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 reasons)indicated below by the checkmark(s)I have placed ❑YES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable Items) (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, ?"0 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 Stale License Law (Chapter 9 (commencing with INFORMATION GUIDE AND THE SCAQMD PERMITTING
Section 7000)of Division 3 of the Business and Professions Code)or that he or YES
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($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL AEPORTING.
compensation,will do ( )all of or( ) porting of the work, and the structure is PROPiR '. O AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code•,
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
II
BUILDING • SAFETY PERMIT/PLAN
• 1 APPLICATION
III
/
Menifee
DATE j 'r p PERMIT/PLAN CHECK NUMBER lS—
t
TYPE: u COMMERCIAL XRESIDENTIAL C; MULTI-FAMILY MOBILE HOME 0 POOL/SPA O SIGN
SUBTYPE: O ADDITION C ALTERATION O DEMOLITION C' ELECTRICAL ()(tNECHANICAL
NEW Q PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS 'C.L
ASSESSOR'S PARCEL NUMBER �J /�� ,- � / LOT _( TRACT p1
OWNER NAME �-t�t)4 ! Old )C-CASS-e-( '
ADDRESS
PHONE ,� EMAIL
APPLICANT NAME Ll\yU L \-k a
ADDRESS IM-t_ 6L to w
PHONE EMAIL
CONTRACTOR'S NAME /p . Ca�a�- ��`� OWNERBUILDER7 (DYES)(NO
BUSINESS NAME �{.,C,,1f u_LC lvl 1 r ,�/� �?
ADDRESS ��n C�""�' 1/�— �//I Y//I�� ,�/� ,, y// � S
PHONE I Ste' (!/�V �—'� EMAIL tq20..r C v,ee Cc 6` d&O4 oao , ( ✓'✓?
CONTRACTOR'S STATELIIC NUMBER I ( y CQ ! LICENSE CLASSIFICATION C V
VALUATION$ $ d C (D ID A SQ FT 4 U L SQ FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION An CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 1 SMIP
INVOICE r _�(�J PAID AMOUNT I��
AMOUNT V/ <-' CASH ` HECKp C.'CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT ) CASH "'CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED C%YES C% NO DLNUMBER NOTARIZED LETTER G YES C; NO
City of Menifee Building& Sofety Deportment 29714 Houn Rd. Menifee, CA92586951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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