PMT16-02451 City of Menifee Permit No.: PMT16-02451
29714 HAUN RD.
�A-CCELA— MENIFEE,CA 92586 Type: Residential Mechanical
MENIFEE Date Issued:
08105/2016
PERMIT
Site Address: 30419 MIRANDA DR, MENIFEE, CA Parcel Number: 364-051-003
92584 Construction Cost: $9,200.00
Existing Use: Proposed Use:
Description of HVAC REPLACEMENT,3.5-TON A/C(BACKYARD)AND 90,000 BTU FURNACE(GARAGE)
Work:
Owner Contractor
ALISON OLSON W C HEATING&AIR CONDITIONING INC
30419 MIRANDA DRIVE 41085 GOLDEN GATE CIR
MENIFEE, CA 92584 MURRIETA, CA 92562
Applicant Phone:9516000700
JILL WESTON License Number:779604
W C HEATING&AIR CONDITIONING INC
41085 GOLDEN GATE CIR
MURRIETA, CA 92562
Fee Description - (3ty Amount 151
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 carded 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 orimproves 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 1 am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the.Business and D l am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effem the following reason:
License Class License No..:]74 IS6� By mysignature below l acknowledge that,exceptfor mypersonal residence
Expires S61 It, Signature ,Q� �l�Q,r2 L�J in which l must have resided for at least one year prior towmpletion of
improvements covered by this permit.I cannot legallysell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner builder if it has not been constructed in its entirety by
DIherebyaffirmunderpenaltyofperjuryoneofthefollowingdeclarations:) licensed contractors.I understand that a copy of the applimble 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 of the Labor Code,for the performance of work for which yvww.Ieeinfo.ca.Rov/calaw.html.
this permit is issued.
Policy# - Date
�y/_I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
4ection 3700 of the Labor Code,for the performance of the work for which o By my signature below l certify to 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 owners behalL l have read this
numberare: t �y application and the information l have provided is correct.l agree to comply
Camierlr lC S�TLICG 1.7� t'VLr��"L!� with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city,or county to
Policy# WC,W 1.O3VL5i Expires I I k ) enterthe above identified property for inspection purposes.
(This section need notto be completed Is the permit is for one-hundred Date '
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
ol certify that In the performance of the work for which this permit isissued, O J�aoa
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSEg
workers compensation laws of California,and agree that III should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions ofsection 3700 ofthe Labor
Code,I shall forthwith comply with those provisions. I Will the applicant or future building occupant handle hazardous material or
Applicant W -� Date 7r �l g' �1� mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FA URETO SECURE WORKER'S COMPENSATION COVERAGE IS Oyes "°
UNLAWFUL,AND SHALLSUBIECT AN EMPLOYER TO CRIMINALPENALTIES Will the intended use ofthe 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 CoastAir Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY OYes 00
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 100Dfeet ofthe
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) OYes ?NO
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 l am exempt from the California Health&Safety Code,Section 25SUS 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
OYe
Business and Professions Code).Any city or county that requires a permitto 6 9,. , Date 5"2D'L'D
construct,alter,improve,demolish or repair any structure,priorto its PROPE !OWNER OR AUTHORIZED AGENT
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 EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe The EPA Renovation,Repair and Paintfng(RRP)Rule requires contractors
Business and Professions Code)or that he orshe is exempt from licensure receiving compensation for most work that disturbs paint in a pre4976
and the basis for the alleged exemption.Any violation ofsection 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 workthemselves orthrough their
Ol,as owner ofthe property,or my employee with wages as theirsole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all ofor( )portion ofthe work,and the structure is www.eoa.RuyAead or contact the National Lead Information Centerat
not intended or offered forsale.(Section 7044,Business and Professions 1-BOD-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of 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 Certirrcation No:
completion,the Owner-Builder will have the burden of provingthat it was
not built or improved for the purpose of sale. O No EPA Lead-Safe Certified Firm is required forthis project because:
O 1,as owner ofthe property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does notapply to an owner of a Ifyour project does notcompfy with EPA RRP rule pleasefill out the RRP
Acknowledgement.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
Menifee
DATE 0110BI2016 PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA [:]SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION [-]DEMOLITION ❑ELECTRICAL Z MECHANICAL
❑NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK HVAC REPLACEMENT.3.5 TON A/C (BACKYARD)90,000 BTU FURNACE(GARAGE)
PROJECTADDRESS 30419 MIRANDA DR Ct P113.,f♦
ASSESSOR'S PARCEL NUMBER LOT TRACT of Menifee
PROPERTY OWNER'S NAME ALISON OLSON Bullding &S2 Y pt.
ADDRESS 30419 MIRANDA DR AUG
PHONE (951)285-9068 EMAIL
APPLICANT NAME JILL WESTON
ADDRESS 3645 RUFFIN RD 330-335 SAN DIEGO,CA 92123
PHONE (619)384-6622 EMAIL
CONTRACTOR'S NAME RUSSELLCOCHRAN OWNERBUILDER? ❑YESONO
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$ $9,200.00 SQFT LSO,FT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN I SMIP k
INVOICE PAID AMOUNT
AMOUNT •0 •1 D O CASH O CHECKN O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH OCHECK# OCREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES U NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menefee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection RegUest Line 951-246-6213
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