PMT16-02485 City of Menifee Permit No.: PMT16-02485
29714 HAUN RD.
�CCEI/-> MENIFEE,CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 0 810 312 01 6
PERMIT
Site Address: 26906 OAKMONT DR, MENIFEE, CA Parcel Number: 337-332-026
92586 Construction Cost: $11,000.00
Existing Use: Proposed Use:
Description of REPLACE HVAC W/R-8 DUCT REPLACEMENT, 3 TON 19 SEER A/C70,000 BTU,80%AFU
Work:
Owner Contractor
RAUL GUEDEA BURGESONS HEATING AND AIR CONDITIONING
26906 OAKMONT DR INC
MENIFEE, CA 92586 P O BOX 7310
Applicant Phone:9097933685
DIANNE BURGESON License Number:263871
BURGESONS HEATING AND AIR CONDITIONING INC
P O BOX 7310
REDLANDS,CA
Fee Description OQt Amount(SI
Forced-Air or Gravity-Type Furnace or Bumer 1 149.00
Air Handling/Condensing Units SFR 1 133.06
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_8Idg_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractors)pursuant to the Contractors State License taw).
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 CClalassZ �� License No Z- By my signature below I acknowledge that,except for my personal residence
Expiresr — - Signature in which 1 must have resided for at least one year prior to completion of
/r , / improvements covered by this permit.I cannot legally sell a structure that
WORKER'S COMPENSATION DECLARATION 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 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.IeginI5c.m.gov/caIaw.htmI.
this permit is issued.
i
Policy 8 Date
PROPERTY OWNER OR AUTHORIZED AGENT
o I have and will maintain workers compensation insurance,as required by
section 3700 of the tabor Code,for the performance of the work for which o 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: �r / application and the information I have provided is correct.I agree to comply
Carrier 1 with all applicable city and county ordinances and state laws relating to
q building construction.I authorize representatives of this city or county to
Policy#e!49.f, ZSC c 2 L Expires A5- IfT enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($10D)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued, 4ti/7.s1
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSER Dy! ,e
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to thew refs compensation provisions of Section 3700 of the Labor
Code,I shall jthwith ply with those provisions. QR Will the applicant or future building occupant handle hazardous material or a
Applira ate,p)T annomixturecontaifiedong a hazardous material
Materials
to Information
ationrthatthe
amountsns�ecified on the Hazardous Materials Information Guide?
WAR G:FAIL TOSECUIP RKER'S COMPENSATION COVERAGE IS oYes o
UNLAWFUL,FUL,AND SHALL SU JE AN EMPLOYER TO CRIMINAL PENALTIES WIII the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($300,000),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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guide11 es
CONSTRUCTION LENDING AGENCY ayes o
I hereby affirm that under the penalty of perjury there is a construction WIII 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 boqjdary of a school?
(Section 3097 Civil Code) a Yes No
OWNER BUILDER DECLARATIONS I have Ld the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exemptfrom the permitting checklist.I understand my requirements under the State of
California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below bythe hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oy
es {
Business and Professions Code).Any city or county that requires a permit to Date,' �p
construct,alter,improve,demolish or repair any structure,prior to its a NE RA THORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement A <
that he or she is licensed pursuant to the provisions of the Contractors State EP ENOVATI N RE PAIR AND PAINTING IRRP
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
a 1,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.eovAead 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 o An EPA Lead-Safe Certified Renovator will he 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:
ci 1,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 PERMIT/PLAN CHECK APPLICATION
Menifee
DATE r PERMIT/PLAN CHECK NUMBER 011l0-
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY C MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION 0 ELECTRICAL O MECHANICAL
C NEW 0 PLUMBING 0 RE- OOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 9.4 A,7
r
P ®
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER �'J 1 T �� TRACT
OWNER NAME �+
ADDRESS c�
PHONE EMAIL
APPLICANT NAME
ADDRESS � C) 7
PHONE ��f [p 7 7 �L � l
Z, ' 7 ,mi EMAIL
CONTRACTOR'S NAME / I OWNER BUILDER O YES ONO
BUSINESS NAME /,�./1
ADDRESS pp �� . -p ,ry a,[ U 23
PHONE /�� ,L,L,� �l EMAIL
CONTRACTOR'S STATE LIC NUMBER��6� n 7Z_ LICENSE CLASSIFICATION
VALUATION $ ozrt SOFT t<2FO L SO,FT
APPLICANT'S SIGNATURE DA3IE '
DEPARTMENT DISTRIBUTION CITY OF�MM�ENI/IyE•BBU,SI NESS LICENSE NUMBER
BUILDING PLANNING rjINEEWNG FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT C CASH 0 CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT I 0CASH 0CHECK# OCREDITCARD VISA/Mc
OWNER BUILDER VERIFIED OYES O NO DLNUMBER. NOTARIZED LETTER C YES 0 NO
City of Menifee Building&Safety Department 29714 Noun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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