PMT16-03047 City of Menifee Permit No.: PMT16-03047
29714 HAUN RD.
45ACCELA-> M ENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 09114/2016
P E R M I T
Site Address: 26053 DESERT ROSE LN, MENIFEE,CA Parcel Number: 335-520-043
92586 Construction Cost: $8,804.00
Existing Use: Proposed Use:
Description of REPLACE 5 TON(16 SEER)A/C UNIT&COIL
Work:
Owner Contractor
JERRY BEHRENS PEACH HOME SERVICES INC
26053 DESERT ROSE LN 532 MALLOY COURT
MENIFEE, CA 92586 CORONA, CA 92880
Applicant Phone:7144628174
JANE RECKTENWALD License Number:989511
PEACH HOME SERVICES INC
532 MALLOY COURT
CORONA, CA 92880
Fee Description Qtv Amount($
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 buillifing operations being carded 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_Perrnjt—Temp1ate.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 ci 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_c9p, License No. By my signature below I acknowledge that,except for my personal residence
Expires Signature in which I must have resided for at least one year ptiorto completion of
improvements covered by this permit.I cannot legallysell a structurethatl
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
a 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. www.legInfo.ca.gov/uIaw.htmI.
Policy# Date
ci I have and will maintain workees compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor 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 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
Carrier t%fQ ovia kA — RtAojv-r,4 building construction.I authorize representatives of this city or county to
Policy#WC4'-gffi 4!M�q Expires a—m6 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less 5�;� —Date 0,-14—t(o
PROPERTY OWNER OR AUTHeKIZED AGENT
o I certify that in the performance of the work for which this permit Is issued,
Ishallnotemol any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
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 Labor
Code,I shall forthwith co wi e provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant %— mixture containing a hazardous material equal to-or greater that the
_Date 3-14 41,o amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURWORKER'S COMPENSATION COVERAGE IS a Yes .0
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENA
LTIES 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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguldelines
CONSTRUCTION LENDING AGENCY 0 Yes FNo
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) n Yes #�k-
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
California Health&Safety Code,Section 25505 and 25534 concerning
Contractor'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 7031.5 oYes Yflo
Business and Professions Code).Any city or county that requires a permit to
construct,alter,improve,demolish or repair any structure,prior to its ��—Date
issuance,a Iso requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AuTHbMZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING MRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requims 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 RAP-certified firms and comply with
an Applicant for a perm it 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 propeft or my employee with wages as their sole employees.For mom information about EPA!s Renovation Program visit:
compensation,will do I )all of or( )portion of the work,and the structure is www.epa.govIlead or contact the National Lead Information Center at
not Intended or offered for sale.(Section 7044,Business and Professions I-BOD-424-LEAD(5323).
Code;The Contractor's State License Law does 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 have the burden of proving that it was
not built or improved for the purpose of sale. u No EPA Lead-Safe Certified Firm is required for this project because:
u 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State ricense Law does not apply to an owner of a If your project does not comply With EPA RRP rule please 1111 out th e RR P
Acknowledgement.
BUILDING & SAFETY PERMIT/FLAN CHECK APPLICATION
,�- EMenifee
Admb��
DATE PERMIT/PLAN CHECK NUMBER fwltp- 0-:�04-7-
TYPE: 0 COMMERCIAL VRESIDENTIAL 0 MULTI-FAMILY G MOBILE HOME 0 POOL/SPA 0,SIGN
SUBTYPE: 0 ADDITION 0 ALTERATION 0 DEMOLITION 0 ELECTRICAL -) MECHANICAL
ONEW VPLUMBING QRE-ROOF-NUMBEROFSCIUARES—
DESCRIPTION OF WORK -Replace 5 ton (16 seer) A/C unit & coil
PROJECTADDRESS 26053 Desert Rose Ln
ASSESSOR'S PARCEL NUMBER _335-520-04 LOT TRACT '50sv-7
OWNERNAME Jer Behrens
ADDRESS -26053 Desert Rose Ln
PHONE _gag-641-A8D8 EMAIL
APPLICANT NAME
ADDRESS
PHONE 714-33 -6159 EMAIL manereckaaft.net
CONTRACTOR'S NAME The Prompt Plumber OWNER BUILDER? 0 YES VNO
BUSINESS NAME
ADDRESS 532 M ljoy Crt Corona, CA 92880
PHONE 714-462-8174 EMAIL
CONTRACTOR'S STATE LIC NUM13ER 9895 1 LICENSE CLASSIFICATION 1336
VALUATION$ 8 804,00 SO FT L SO FT
APPLICANT'S SIGNATURE DATE 9-14-16
DEPARTMENT DISTRIBUTION CITY OCENIFELBUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMiP
INVOICE PAIDAMOUNT
AMOUNT 06Aq,10 I I OCASH OCHECK9 -)CREDITCARD VISA/MC—
PLAN CHECK FEES PAIDAMOUNT CASH OCHECK 4 0 CREDIT CARD VISA/MC
OWNER BUILDERVERIFIED Gj YES ;' NO DL NUMBER NOTARIZED LETTER r) YES 0 NO
City of Nieflife,Boildilic) & solely Departawt 29714�,Lfaur Rd. hieoifee, CA 92586 951-672-6777
Inspecrion R: jue5t Litic�51-245 6213
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