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PMT15-01698 City of Menifee Permit No.: PMT16-01698 29714 Type: Residential Mechanical MENIFEEEE,, CA 92586 C 92 40" , MENIFEE Date Issued: 06/19/2015 �I PERMIT Site Address: 29627 AVENIDA DE REAL, MENIFEE, CA Parcel Number: 336-262-019 92586 Construction Cost: $5,550.00 Existing Use: Proposed Use: Description of REPLACEMENT OF EXISTING HVAC SYSTEM WITH NEW 3 TON HVAC SYSTEM Work: Owner Contractor MARIA NORLAND CASTILLO HEATING&AIR CONDITIONING INC 29627 AVENIDA DE REAL 32105 HEATHER LANE MENIFEE, CA 92586 MENIFEE, CA 92584 Applicant Phone: 9513014452 ADRIANA CASTILLO License Number: 548323 CASTILLO HEATING &AIR CONDITIONING INC - 32105 HEATHER LANE MENIFEE, CA 92584 Fee Description Qtv Amount l$1 Air Handling/Condensing Units SFR 1 133.00 uldlrti a lvs cer :7i00'- 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 Pagel 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 ,(Icensed. Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions License icens a Professions Code and my license Is In full torte and effect. Code:The Contractor's License Law does not apply to an owner of a property License Glass,�,..ZLicense No, L4 who builds or improves thereon, and who contracts for the projects with a Expires( Signaturef1.�;11 licensed contractar(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DE RATION -. ❑ 1 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 for by Section 3700 of the issued Labor Code,for th the Director of e performancal e Hons as of work for whichh this which I must have mslded for at least one year prior to completion of permit is issued. improvements covered by this permit,I cannot legally sell a structure that I have 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 I have and will maintain warkers' 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 site:htto/lwww leginfo ca ovlcalaw html. permit is.issued.My workers'compensation insurance tamer and policy number are: Carrier G0,T E ropey wneror u arse gent Date Expires i 0 ++ 01 j Z 0 1 S Policy# CIf.7 29 5(o Name of Agent< rg, e1 01h&00 Phone ❑ By my Signature below, I certify to each of the following: I am the property owner or authorized to act on the property owners 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($100)or less) with all applicable city and county ordinances and state laws relating to building construction.I authorize re re ati es of his�C1ry or count to enter the above- 0 "I certify that in the performance of the work for which this permit is issued,1 identified proparty.for m salon pru 6r! y shall not employ any persons In any manner so as to become subject to the /// s workers"compensation laws of California, and agree that if I should become I�o e 0 JI / l$/17/2015 subject to the workers'compensation provisions of Section 3700 of the Labor pr ner orAuthorized A Code,I shall forthwith comply with those provisions. gent Date Date; 6/17/2015 Applicant; City B mass License# C a 7 WARNING, FAILURE TO' ECURE WORKERS' H® ARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE IS NLAWFUL, 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 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 LE,U61Ne3 AGENIPY 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 3097 Civil Code) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE Lender's Name ❑Y�ES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION Lender's Address t FROM THE SOUTH COAST AIR QUALITY MANAGEMENT 0 DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR OWNER BUILDER DECLARATIONS GUIDE LINES I hereby affirm under penalty of perjury that I elm 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 7081.5.Business and Professions Code:`A BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A `Airy city or county that requires a permit construct,alter,Improve,demolish, IO 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 OES 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($600).) CODE SECTION 2550 33 AN C NCERNING ❑ I, as owner of the property. y employees g HAZARDOUS MATER EP`RTIN .p p rty, or m am Ia ees with wages as their sole i compensation,will do( )all of or( )porting of the work,and the structure is PROP RTY� WNE AYY 1 not Intended or offered for sate.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a pmparty, X 4 tom_ who, through employees'or personal effort, builds or improves the property, C f —'-- provided that the improvements are not intended or offered for sale.If,however, J - the building or Improvement is sold within one year of completion,the owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). C & SAFETY PERM IT/PLAN CHECK APPLICATION Y ' M. City of Menifee Menifee Building Dept 1 DATE ,�mg PERMIT/PLAN CHECK NUMBER ��L�'a(0 q 1 p D TYP • t I:' COMMERCIAL RESIDENTIAL 0 MULTI-FAMILY : MOBILE HOME �> POOL/SPA ;i SIGN S leCeriv vO'o O ALTERATION O DEMOLITION :' ELECTRICAL VMECHANICAL NEW . UMBING 'i RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK replacement of existing system with new 3 ton HVAC system PROJECT ADDRESS 29627 Avenida de Real Sun City, CA 92586 ASSESSOR'S PARCEL NUMBER LOT 119 — TRACT OWNER NAME Maria Nordland ADDRESS 29627 Avenida de Real Sun City, CA 92586 PHONE 951-672-6196 EMAIL marynordland@hotmail.com APPLICANT NAME Adriana Castillo ADDRESS 32105 Heather Lane Menifee, CA 92584 PHONE 951-301-4452 EMAIL info@castillohvac.net CONTRACTOR'S NAME Art Castillo OWNER BUILDER? 0 YES "NO BUSINESS NAME Castillo Heating and Air Conditioning, Inc. ADDRESS 32105 Heather Lane Menifee, CA 92584 PHONE 951-301-4452 EMAIL info@castillohvac.net CONTRACTOR'S STATE LIC NUMBER 548323 LICENSE CLASSIFICATION C20 VALUATION$ 5,550 SO FT 1600 L SQ FT 7405 APPLICANT'S SIGNATURE DATE 6/17/2015 CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP INVOICE PAID AMOUNT AMOUNT :% CASH 0CHECK# ^CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT :iCASH ::iCHECK# :%CREDITCARD VISA/MC OWNER BUILDER VERIFIED -C%YES C) NO DL NUMBER NOTARIZED LETTER O YES :% NO City of Menifee Building&Safety Department 29714 Houn Rd. 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