PMT16-02104 City of Menifee Permit No.: PMT16-02104
29714 HAUN RD. Type: Residential Mechanical
</ACCELA— MENIFEE, CA 92586
MENIFEE Date Issued: 07/0 612 01 6
PERMIT
Site Address: 28652 AMBORELLA WAY, MENIFEE, CA Parcel Number: 364-213-011
92584 Construction Cost: $3,000.00
Existing Use: Proposed Use:
Description of REPLACE A/C COIL&CONDENSER 5 TON
Work:
Owner Contractor
RENEE TAYLOR TRUTEAM OF CALIFORNIA INC
28652 AMBORELLA WAY 260 JIMMY ANN DRIVE
MENIFEE, CA 92584 DAYTONA BEACH, FL 32114
Applicant Phone:3863042222
ED PONCE License Number:221517
TRUTEAM OF CALIFORNIA INC
260 JIMMY ANN DRIVE
DAYTONA BEACH, CA 32114
Fee Description City Amount I$)
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 requiring the correction of errors in the plans and
specifications or from preventing builiding operations being camied an 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 property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and a I am exempt from licensure under the Contractors State License law for
Professions Code and my license is in full force and effect. the following reason:
License Class C 2d License
INo. o?.? 17 By my signature below I acknowledge that,except for my personal residence
Expires 9-30-„70)T Signature�o�✓ yi in which l must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder B it has not been constructed in its entirety by
❑I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for workers 7044 of the Business and Professions Code,is available upon request when
compensation,Issued by the Director of Industrial Relations as provided for this application is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which www.leginfo.ca.gov/calaw.html.
this permit is Issued.
Date
Policy R
PROPERTY OWNER OR AUTHORIZED AGENT
have and will maintain workers compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which A9 By my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: ��// application and the information I have provided is correct I agree to comply
Carder /7�" ITW e,r r R-' with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# L/LYL-�21.7rr L- Qlee> Expires 6/?d /1 7 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred 'e � Dat?(/G kc,/7
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued, �G/�
I shall not employ any persons in any manner so as to become subject O to the CITY BUSINESS LICENSE g ����sJo �'
IZ
workers compensation laws of California,and agree that if 1 should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
/l //J mixture containing a hazardous material equal to or greater that the
Applicant =v r✓f� Date �17 amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes 0
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQM D)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes MQ
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) Dyes B610
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Cade,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes ONG Business and Professions Code).Any city or county that requires a permit to � � Date 7/6117
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant for the perm it to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eua.Rov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a a An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.if,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project because:
o I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please flit out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE 0 7/0 612 0 1 6 PERMIT/PLAN CHECK NUMBER 1%0- O�'O
TYPE: ❑COMMERCIAL DffRESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: [—]ADDITION []ALTERATION ❑DEMOLITION [-]ELECTRICAL MMECHANICAL
[]NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Replace A/C coil and condenser.5 Ton
PROJECT ADDRESS 28652 Amborella Way,Menifee, CA 92584
ASSESSOR'S PARCEL NUMBER 364-213-011 LOT 55 TRACT Retl7T 3
PROPERTY OWNER'S NAME Renee Taylor
ADDRESS 28652 Amborella Way, Menifee,CA 92584
PHONE (714)323-9462 EMAIL
APPLICANT NAME Ed Ponce-Truteam of CA Inc
ADDRESS 475 Rivera St,Unit:D,Riverside, CA 92501
PHONE (951)722-6905 EMAIL edward.ponce@truteam.com
CONTRACTOR'S NAME Truteam of CA Inc OWNER BUILDER? ❑YES❑✓NO
BUSINESS NAME
ADDRESS 475 Rivera St, Unit: D,Riverside,CA 92501
PHONE (951)683-4429 EMAIL
CONTRACTOR'S STATE LIC NUMBER 221517 LICENSE CLASSIFICATION C20
VALUATION$ $3,000.00 SQ FT 2374 L SQ FT
APPLICANT'S SIGNATURE DATE 07/06/2016
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY of MENIFEE 6USINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN I SMIP
INVOICE 'C PAIDAMOUNT
AMOUNT I (D CASH 0CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department29714 Houn Rd. Menifee, CA 92586951-672-5777
www.cityof,nenifee.us Inspection Request Line 951-246-6213
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