PMT16-00473 City of Menifee Permit No.: PMT16-00473
29714 HAUN RD. Type: Residential Mechanical
�A-CCEL/k? MENIFEE, CA 92586
MENIFEE Date Issued: 03/02/2016
PERMIT
Site Address: 31874 RUXTON ST, MENIFEE,CA 92584 Parcel Number: 360-580-001
Construction Cost: $8,500.00
Existing Use: Proposed Use:
Description of REPLACE 3.5 TON AC&COIL
Work:
Owner Contractor
PAT SHIELDS W C HEATING&AIR CONDITIONING INC
31874 RUXTON ST 41085 GOLDEN GATE CIR
MENIFEE,CA 92584 MURRIETA,CA 92562
Applicant phone:9516000700
ERIC BARNETT License Number:779604
W C HEATING&AIR CONDITIONING INC
41085 GOLDEN GATE CIR
MURRIETA, CA 92562
Fee Description Qtv Amount f81
Forced-Air or Gravity-Type Furnace or Burner 1 149.00
Air Handling/Condensing Units SFR 1 133.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Mechanical 1 14.10
$324.10
The issuance of this permit shall not prevent the building official from thereafter requidng 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 staled,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_Pennit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'State License Law forth
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence 1
Professions Code andjW license is in full force and effe t , 6� cannot which I must have resided for at least one year prior to completion r
License Class �`�+ Li �Jo. 7'7 � improvements covered by this permit I legally sell a structure that I hav
Expires 6 �0 Hd Signature ItcenseLJ built as an owner-building if it has not been constructed in Its entirety by license
contractors. I understand that a copy of the applicable law, Section 7044 of th
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application 1
submitted or at the following Web site:
❑ I hereby affirm under penalty is perjury one t the following for workers; htto://www.lecinfD.ca.aov/calaw htm1.
I have and will maintain a certificate of consent of self-insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the propert
W I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read thi
section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct I agree to compl;
permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to building
q �„/,�E ,/� �� construction,I authorize representatives of this city or county to enter the above
Carrier , S/T I 4y identified property for the inspection purposes.
Policy# WCVM70X i_^ Expires Date
Property Owner or Authorized Agent
(This section need not be completed if the permit is for City Business License# v ��
one-hundred dollars($100)or less) ty
❑ I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not emolov any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers'compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide?
Code,I shall forthwith comply with those provisions. DYES fyrv0
Applicant; Date; ZL/7I/1C Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelinJ�
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES ?NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundaryof chool?
LABOR CODE, INTEREST,AND ATTORNEYS FEES OYES NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health&Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous anal reporting.
OWNER BUILDER DECLARATIONS ❑YES 0 ^,
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date gh 7/6!S
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5.Business and Professions Code:
Any city or county that requires a permit to construct, alter,improve, demolish, EPA RENOVATION,REPAIR AND PAINTING(RRP)
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 The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's Stale License Law(Chapter 9(commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit:
❑ www.epa.gov/lead or contact the National Lead Information Center at
I, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(5323).
compensation,will do( )all of or( )porting of the work,and the structure is
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 ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name:
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 Firm Certification No.:
purpose of sale).
❑ 1, as owner of the property an exclusively contracting with licensed 11 No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
SAFETYBUILDING & PERMIT/PLAN CHECK A• r I§. •211
MInniiee
DATE 02/23/2016 PERMIT/PLAN CHECK NUMBER o
TYPE: [:]COMMERCIAL ❑✓ RESIDENTIAL [-]MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: []ADDITION []ALTERATION ❑DEMOLITION [-]ELECTRICAL ❑MECHANICAL
[]NEW [-]PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK REPLACE 3.5 TON AC AND COIL
PROJECTADDRESS 31874RUXTON
ASSESSOR'S PARCEL NUMBER -6j.4 f5W- 00' LOT TRACT
PROPERTY OWNER'S NAME PAT SHIELDS
ADDRESS 31874 RUXTON
PHONE (630)632-7701 EMAIL
APPLICANT NAME ERIC BARNETT
ADDRESS 3645 RUFFIN RD 330-335 SAN DIEGO, CA 92123
PHONE (619)384-6622 EMAIL ERIC@WEGREENINC.COM
CONTRACTOR'S NAME RUSSELL COCHRAN OWNER BUILDER? ❑YES❑✓ NO
BUSINESS NAME WC PLUMBING, HEATING&AIR
ADDRESS 41085 GOLDEN GATE CIR MURRIETA,CA 92562
PHONE (951)600-0700 EMAIL
CONTRACTOR'S STATE LIC NUMBER 779604 LICENSE CLASSIFICATION C20
VALUATION $ $8,500.00 SO FT 2106 L SO FT
APPLICANT'S SIGNATURE DATE
FF USE r
DEPARTMENT DISTRIBUTION �� CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE '17 b :7 PAID AMOUNT
AMOUNT J • 0CASH 0 CHECK N CREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER O YES 0 NO
amity of Nlenifee Srii;iinq �� Sa/e:y Depur tmen;i97t4 Hnun Rd. 1Vleaij`-t'e, CA 923&0 9,i072 L777
wwUi.dtyefinenifeaus Inspection Request Line 951-Z46-6Z73
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