PMT15-01814 i
City of Menifee Permit No.: PMT15-01814
29714 HAUN RD.
MENIFEE, CA 92586
Type: Residential Mechanical
i
MENIFEE Date Issued: 06/30/2015
i
PERMIT
Site Address: 29571 PLEASANT PASEO CV, MENIFEE, Parcel Number: 333-560-014
CA 92585 Construction Cost: $2,000.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING EVAPORATIVE COIL ONLY
Work:
Owner Contractor
CRYSTAL CLARK BEAR CREEK HEATING AND AIR CONDITIONING
29571 PLEASANT PASEO COVE INC
MENIFEE, CA 92585 24069 CHATENAY LANE '..
Applicant Phone: 9516002882
VALERIE DUNGAN License Number: 779461
BEAR CREEK HEATING AND AIR CONDITIONING INC
24069 CHATENAY LANE
M U RRI ETA, CA 92562
Fee Description Qtv Amount is
i H tl1bgF eaig�` i 3,--_
Building Permit Issuance 1 27.00
N`F�Ed
$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_Templatarpt 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 Ty license Is infullMnct. -- - - -- - - - - - Code:The Contractor's License Law does not apply to an owner of a property ---
License Cllaass2 C Licens / who builds or improves thereon, and who contracts for the projects with a
Expires `� 31 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 asan 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
I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
ection 3700 of the Labor Code, for th performance of the work for which this submitted or at the following Web site:httr)://mm.leciinfo.ca.ciov/calaw.html.
permit is issued.�Iqy workers c pensat' n insurance carrier and policy number are:
rN (, Property Owner or Authorized Agent
Carrier I ((( Date
Expires �.) 0 � / P/rolicy# ��NN �"�� 25/`� / �l
Name of Agent -7 '`r bat 1IIVfbone# !9144. �( 5C14t)`( ` ❑ By my Signature below, certify to each of the following: am the property
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 slate laws relating to building
construction. I authorize representatives of this city or county to en er th above-
❑ I certify that in the performance of the work for which this permit is issued, identified rop�rty the inspeption 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
Code, I shall to wit comply with those pr vi 'on . Pro ny Ow ear or Authorized Agent -Date
1 �Xn City Business License# 0 : 6,2 7 D
Date; 4�- 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, DYES 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 DNO 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 DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ❑NO DISTRICT (SCAQMD)SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS GUIDE LINES (7
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME: rA
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
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 ❑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 DEPORTING.
compensation, will do ( ) all of or( ) porting of the work, and the structure is PROPERTY OWNER ORAUTHORIZED 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 properly 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).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
FMenifee
DATE J PERMIT/PLAN CHECK NUMBER —�
TYPE: ) COMMERCIAL XRESIDENTIAL C" MULTI-FAMILY C) MOBILE HOME -, POOL/SPA " SIGN
SUBTYPE: CG ADDITION O ALTERATION Ci DEMOLITION =t ELECTRICAL MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK va yA'X_
�46 An
PROJECTADDRESS ''c-Y��� . v2_
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME Crv4,5d (.l,i L
ADDRESS L Gt.�y6 v city Of Me cy Dep4•
Bu
PHONE EMAIL JON
2015
APPLICANT NAME I `,�. D,
ADDRESS e ved
PHONE EMAIL
Q
CONTRACTOR'S NAME ( r OWNER BUILDER? 0 YES NO
BUSINESS NAME Q (,L.. ,�l �6vjv k6Ai rp SACAq
ADDRESS D nn✓ UVy y-1
PHONE �,�� LSD ( � �-- EMAIL CS��/ V�f" f�I�YY� •C
CONTRACTOR'S STATE LIC NUMBER 4 � ( LICENSE CLASSIFICATION
VALUATION $ fi Op SO FT ��� L SO FT
n
APPLICANT'S SIGNATURE DATE
LCITY STAFF USE ONLY 110��6
DEPARTMENT DISTRIBUTION y� CITY Of MENI�FELE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN �� SMIP '` (�
INVOICE PAID AMOUNT ' ^
AMOUNT ��` W 1 << CASH "t'CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT +.. CASH CDCHECK# QCREDITCARD VISA/MC
OWNER BUILDER VERIFIED YES 0 NO DL NUMBER NOTARIZED LETTER G YES 'C% NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-572-6777
www.cityofinenifee.Lis Inspection Request Line 951-246-6213
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