PMT15-01922 i
City of Menifee Permit No.: PMT15-01922 {
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 07/08/2015
I
I
PERMIT
Site Address: 29895 AVENIDA DE CORTEZ, MENIFEE, Parcel Number: 336-242-010
CA 92586 Construction Cost: $11,000.00
Existing Use: Proposed Use:
Description of REPLACE HVAC&DUCTS
Work:
Owner Contractor
RON &TAMMY SWAIN PRIORITY ONE INC
29895 AVENIDA DE CORTEZ 28669 PATTI LANE
MENIFEE, CA 92586 SUN CITY, CA 92585
Applicant Phone: 9519285667
STEVE RUDAS License Number: 753163
PRIORITY ONE INC
28669 PATTI LANE
SUN CITY, CA 92585
Fee Description Qtv Amount
Air Handling/Condensing Units SFR 1 133.00
e u
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 slated, 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
a
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 y license is In full force and a ect.
�., � Code:The Contractor's License Law does not apply to an owner of a property
License Class License who builds or improves thereon, and who contracts for the projects with a
Expires / �6 Signature=m licensed contractors)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
/// ❑ I am exempt from licensure under the Contractors'Slate License Law for the
ga 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 acknowledge that, except for my personal residence in
compensation, issued by the Director of Industrial Relations as provided for by
Section 3700 of the Labor Code, for the performance of work for which this which I must have resided for at least one year prior to completion of
permit is issued. q improvements covered by this permit, I cannot legally sell a structure that I have
Policy# 5�7e�/�� U 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
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 the following Web site:http'llwww leginfo ca gov/calamhtml.
permit is issued.My workers'compensation insurance carrier and policy number are:
S�.,k/' /%�/i✓y .� Property Owner or Authorized Agent
Carrier Date
Expires �� � Zn j Peliey#96>?gVv_, Go/�
❑ 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. 1 agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
construction. I a t orize representatives of this city or county to enter the bove-
❑ 1 certify that in the performance of the work for which this permit is Issued,I identified pr e y for the in. pact! 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 l
subject to the wo kers'compensation provisions f Section 3700 of the Labor Props wn r or Autho d t
Code, shot fort with�mply with those prov s. P 9 to r
City Business License#
Date; Applicant;
WARNI G: 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, AYES 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 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 DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
0
Lender's Address DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS GUIDE LINES
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 checkmaik(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, 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
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 0 UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) "PI CODE, SECTION 25505 25533 AND 25534 CONCERNING
El I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL I#EPORI'ING,
compensation, will do ( )all of or( ) porting of the work, and the structure is PROP T OWNE OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044, Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property, /
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
SAFETYBUILDING & . • APPLICATION
Menifee
DATE !J ' PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL eRESIDENTIAL - MULTI-FAMILY O MOBILE HOME O POOL/SPA G SIGN
SUBTYPE: ADDITION 0 ALTERATION .% DEMOLITION ELECTRICAL j 'MECHANICAL
O NEW C) PLUMBBIINN.G " RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK �Z� L �/ !✓ � �(JG�j
PROJECT DDRE � / ��/
A ss �9,� ,�? l� 1 jJf� 610007-45Z
ASSESSOR'S PARCEL NUMBER �J�1D Qp��1 LOT (DI TRACT Ufto
OWNER NAME W, ,-J Pe m rn ,,?/
ADDRESS / 9 2y 4- '�
PHONE 7 Ion- ���//� EMAIL n
APPLICANT NAME j// / G �LZJyT�J
ADDRESS �6 b _ G1,1 Y6
n'6--
PHONE � , 3?7 e� 23/ EMAIL ,5%Z(J yi lL�ly
CONTRACTOR'S NAME -10 �l D✓''/� �//Ci OWNER BUILDER? OYES
BUSINESS NAME
ADDRESS T T /
PHONE CJ,�J .j�7 ro Z.,fi EMAIL
CONTRACTOR'S STATE LIC NUMBER -S ?2 LICENSE CLASSIFICATION CZ_�� GS fj
VALUATION$ // OCR U SO.FT L SQ FT r�
APPLICANT'S SIGNATURE DATE -7 d ✓l`
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ,M CI OF MENIFE $USINE55 ICENSE NUMBER
O
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP 3-74S7
INVOICE PAID AMOUNT
AMOUNT o % CASH ':.%CHECK# i.%CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT iCASH %CHECK L.iCREDITCARD VISA/Mc
OWNER BUILDER VERIFIED C: YES NO DLNUMBER NOTARIZED LETTER 0 YES 0 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
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