PMT16-03031 City of Menifee Permit No.: PMT16-03031
29714 HAUN RD. Type: Residential Mechanical
'�A—CCELA—> MENIFEE, CA 92586
... MENIFEE Date Issued: 09/13/2016
PERMIT
Site Address: 26552 MEHAFFEY ST, MENIFEE, CA Parcel Number: 335-281-009
92586 Construction Cost; $9,300.00
Existing Use: Proposed Use:
Description of HVAC REPLACEMENT,4 TON A/C,90,000 BTU FURNACE(ROOF)AND ALL DUCT WORK
Work:
Owner Contractor
KAREN YOUNG W C HEATING&AIR CONDITIONING INC
26552 MEHAFFEY STREET 41085 GOLDEN GATE CIR
MENIFEE,CA 92586 MURRIETA. CA 92552
Applicant Phone:9516000700
JILL WESTON License Number 779604
W C HEATING&AIR CONDITIONING INC
41085 GOLDEN GATE CIR
MURRIETA, CA 92562
Fee Description City Amount W
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
Administrative Fee 133 133.00
Administrative Fee 149 149.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Mechanical 1 14,10
$606.10
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of en-ors in the plans and
specifications or from preventing builicling 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_Pemit Template.ript Page 1 of I
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 contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the,Business and a I am exempt from[!censure under the Contractor's State License Law for
Professions Code and my license Is in full force and effect. the following reason:
License Class C'Q(3 License No. By mysignature below I acknowledge that,except for mypersonal residence
Expfres—_QS61 IL signature '��CQ L, t in which I must have resided for at least one year prior to completion of
0 improvements covered by this P21"MiL I cannot legally sell a structure that I
WORKEWS 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 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
this permit is issued. vvvvvv.IeR[nfn.ca.gov/caIavv.htmI.
Policy# Date
ZI ave and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
a,t�,on 3700 of the Labor Code,for the performance of the work for which ci By my signature below I 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 owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this elty or county to
Policy# Expires 1 1�7 enter the above identified property forinspection purposes.
(This section need notto be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
ci I certify 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 UCENSE# 0-36,�og,
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labo,
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater tha t the
Applicant !�4'ii 1 Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAVURETO SECURE WORKER'S COMPENSATION COVERAGE IS 0yes "
UNLAWFUL,AND SHALL SUBJECrAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TOONE 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(SCACMD)?See pannitting checklist
IN SECFICIN 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY oYes i�No
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) ci Yes 9wo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements underthe State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Coda,Section 25505 and 25534 concerning
Contmctor's 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 703M ciYes itflo
Business and Professions Code).Any city or county that requires a permit to L, k3)A2&9n" Date
construct,after,improve,demolish or repair any structure,priortoits NER OR AUTHORIZED AGE��
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 Contra ctor's State EPA RENOVATION,REPAIR AND PAINTING(RRPj
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 l[censure 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 chililcima facility to be RRP-certifled firms and comply with
an Applicant for a permit subjects the applicant to a chill penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves orthrough their
ci 1,as owner of the propeft or my employee With wages as theirsole employees.For mom information about EP9s Renovation Program visit.
compensation,will do I )all of or( )portion of the work,and the structure is www.epa.goy/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 Contractor's State License Law don not apply to an owner of a ci 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 ham the burden of proving that It was
not built or improved for the purpose of sale. C1 No EPA Lead-Safe Certified Firm is required for this project because:
ci 1,as owner of the property am exclusively contracting vidth licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law don not apply to an owner of a If your project does not comply With EPA RRP rule please fli I out the RRP
Acknowledgement
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
"Menifee
DATE 09/1212016 PERMIT/PLAIN CHECK NUMBER
TYPE: 0 COMMERCIAL Z RESIDENTIAL F]MULTI-FAMILY F]MOBILE HOME 0 PCIOL/SPA E]SIGN
SUBTYPE: F]ADDITION []ALTERATION F]DEMOLITION F]ELECTRICAL ZMECHANICAL
FINEW F]PLUMBING F1 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK HVAC REPLACEMENT.4 TON A/C, 90,000 BTU FURNACE(ROOF);ALL DUCT WORK.
PROJECTAIDDRESS 01�06W
ASSESSOR'S PARCEL NUMBER -6W -SM- ocg� LOT TRACT
PROPERTY OWNER'S NAME KARENYOUNG uIty
ADDRESS 26552 MEHAFFEY Building DePt
PHONE (951)501-9878 EMAIL
APPLICANTNAME JILLWESTON
ADDRESS 3645 RUFFIN RD 330-335 SAN DIEGO, CA92123 RE)CE)lVfd
PHONE (619)384-6622 EMAIL
CONTRACTOR'S NAME RUSSELLCOCHRAN OWNERBUILIDER? [:JYESRINO
BUSINESSNAME 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$ $9,300.00 SQ FT 1813 L SQ FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT 111STRIBUTION CITY OF MENIFEE OU51NE55 CICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE � GREEN SMIP
INVOICE I I
AMOUNT PAID AMOUNT LOCU to OCASH OCHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0- NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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