PMT16-02217 City of Menifee Permit No.: PMT16-02217
29714 HAUN RD.
�CCELA MENIFEE,CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 07/13/2016
PERMIT
She Address: 29073 GRIFFITH DR, MENIFEE,CA Parcel Number: 336-100-011
92586 Construction Cost: $22,500.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, PACKAGE UNIT
Work:
Owner Contractor
DANIEL P FOX J D F CONSTRUCTION INC
29013 GRIFFITH DR 1114 E TRUSLOW AVE
MENIFEE, CA 92586 FULLERTON, CA 92831
Applicant Phone:7145261120
JASON CARY License Number:956749
J D F CONSTRUCTION INC
1114 E TRUSLOW AVE
FULLERTON, CA 92831
Fee Description Oft r Amount ftil
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 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 Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who.contracts forthe projects
I hereby affirm under penalty of perjury that I am under provisions of
with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class*�r20.39-/a License No. 4/ �7 By my signature below l acknowledge that,except for my personal residence
Expires 17 Signatur in which I must have resided for at least one year priorto completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLA TION have built as an owner-builder if it has not been constructed in Its entirety by
o 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 worker's 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 ofthe Labor Code,for the performance of work for which v,ww.Ieginfo.ca.eov/calaw.html.
this permit is Issued.
Policy tJ Date
o 1 have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which D By my signature below I certify tq each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.1 have read this
number aryq I C application and the information I have provided is correct.I agree to comply
�J�1�• (�]✓de�,(�r� rl with all applicable city and county ordinances and state laws relating to
C Carrier'�t /y r building construction.I authorize representatives of this city or county to
Policy ryr ✓0003^00 Expires b "/✓ enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
/15nertify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE If
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall h ith comply th those provisions. / Will the applicant or future building occupant handle hazardous material or a
Applican rf Date ( mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:F ILURE TO SECURE WORKER'S COMPENSATI N VERAGE IS o Yes
UNLAWFU ,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will th Intended use of the building by the applicant or future building
AND CIV 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 oyes /o0
I hereby affirm that under the penalty of perjury there is a construction Will theproposed 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 school?
(Section 3097 Civil Code) D Yes o
OWNER BUILDER DECLARATIONS 1 have readthe Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that 1 am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)Indicated below by the California Health al Safety Code,Section 25505 and 25534 concerning
hazardous mate4ERAU
mg.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 �+'es ❑ Jo
Business and Professions Code).Any city or county that requires a permit to /", Date
construct,alter,improve,demolish or repair any structure,prior to its p TY OWNTH
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 Contractors State E RENOVATION,REPAIR AND PAINTING IRRPJ
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 Iicensure 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.epa.gov/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 u 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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
D 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 fill out the RRP
Acknowledgement.
BUILDING & SAFETY • APPLICATION
Menifee
DATE -7 PERMIT/PLAN CHECK NUMBER 1b — Q
TYPE: O COMMERCIAL WRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK ,4AJ Qtl�,q. 0 1
PROJECT ADDRESS O� (�S/6, ^* � J
Lj
ASSESSOR'S PARCEL NUMBER "/1p �Vy 1 LOT p�rt(J TRACT � 1
OWNER NAME Afj Aox
a O r� -f ADDRESS �7
PHONE71y/(9//fs-' Sa� / EMAIL
APPLICANT NAME o �'
ADDRESS
PHONE 7/ (z5 7Sr EMAIL /
CONTRACTOR'S NAME OWNER BUILDER? O YES 4PNO
BUSINESSNAME
ADDRESS U,S/OW LJ ON CC D✓
PHONE �%��a� EMAIL-
CONTRACTOR'S STATE LIC NUMBERS'.jJ7y�/ LICENSE CLASSIFICATIONC-p?O -39
VALUATION$ ,�0 L7 SO.FT (()Q y L SQ FT X '
APPLICANT'S SIGNATURE DATE �7
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION Ivp CITY OF MOENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIPj1/(�/ 2
INVOICE �f„ 1 PAID AMOUNT �,
AMOUNT �J OCASH OCHECK# •CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-5777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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