PMT16-03077 City of Menifee Permit No. PMT16-03077
29714 HAUN RD. Type: Residential Mechanical
'C;kCCELA_> MENIFEE,CA 92586
4-11SA-1 MENIFEE Date Issued: 0911912016
P E R M I T
Site Address: 28996 CROSBY DR, MENIFEE,CA 92586 Parcel Number: 338-042-006
Construction Cost: $9,995.00
Existing Use: Proposed Use:
Description of REPLACE 4 TON A/C IN BACK YARD, COIL&80,000 BTU FURNACE
Work:
Owner Contractor
DOROTHY FULKERSON A-AVIS PLUMBING HEATING&AIR CONDITIONING
28996 CROSBY DR INC
MENIFEE, CA 92586 600 EAST VALLEY BLVD
Applicant Phone:9098253600
STEVEN SCHNIERER License Number:630503
A-AVIS PLUMBING HEATING&AIR CONDITIONING INC
600 EAST VALLEY BLVD
COLTON,CA 92324
Fee Description P—ty. Amount($1
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 preventthe 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 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 o 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 C---�'0 —UcenseNo. 6�-30Sn--'i 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 prior to completion of
improvements covered by this permit.I ca nnot legally sell a structu re that I
WORKER'S COMPENSATION DECLARATION have bu lit 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 www.leginfo.ca.goy/calaw.litmi.
this permit is issued.
Policy f Date
�l have and will-'..t'in w.rkeo s compensation i'n,.uftnce�,s rq'-1wrd by PROPERTY OWNER OR AUTHORIZED AGENT
s ct 0 of b.r By my signature below I certify to each of the following:I am the property
e .370 the La Code,f ,the perfrmn , he okfor h ch Bym
this permit is issued.My workees compensation insurance carrier and policy 4.w—n.,or authorized to act on the property owner's behalf.I have read this
numberare: application and the information I have provided is correct.I agree to comply
5�* with all applicable city and county ordinances and state laws relating to
Carrier -;,� !i—�, -I Expire building construction.I authorize representatives of this city or county to
Policy# 'Na LA 1" — s enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred <�""� �Date qll-dic�
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
a I certifythat in the performance of the work for which this permit is issued,
I shall not employ any persons in any mannerso as to become subject to the CITY BUSINESS LICENSE 9
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 comply with those 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
amountss cified an the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
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 forguld Il
CONSTRUCTION LENDING AGENCY o Yes ;Z
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 b u clary of a school?
(Section 3097 Civil Code) oYesx
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 I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the h zar ous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 s uNo
Business and Professions Code).Any city or county that requires a permit to !;;�� 5—�—Z—�Date It,
construct,alter,Improve,demolish or repair any structure,prior to its PROPERTY 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 Contractor'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 ficensure 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-certffied firms and comply with
an Applicant for a permit subjects the applin nt to a civil pena Ity 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 Rencrnition Program visit:
compensation,will do I )all of or I )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 does not apply to an owner of a 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 Certification No.:
completion,the Owner-Builder will have the burden of proving that It was
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project became:
a 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 License Law does not apply to an owner of a If your project does not comply with EPA RAP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Wenifee
DATE 09/19/2016 PERMIT/PLAN CHECK NUMBER
TYPE: []COMMERCIAL [Z]RESIDENTIAL [:]MULTI-FAMILY F]MOBILEHOME [:]POOL/SPA [-]SIGN
SUBTYPE: F]ADDITION F]ALTERATION E]DEMOLITION [-]ELECTRICAL [ZIMECHANICAL
[-]NEW [—]PLUMBING [I RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Replace 4 ton A/C In Back Yard,Coil,&80.000 BTU Furnace
PROJECTADDRESS 28996 Crosby Drive
ASSESSOR'S PARCEL NUMBER LOT V;5-1 TRACT
OWNER NAME Fulkerson,Dorothy
ADDRESS 28996 Crosby Drive Sun City,CA 92586
PHONE (951)309-1708 EMAIL
APPLICANT NAME Steven Schnierer
ADDRESS 31225 La Baya Drive Suite 112 Westlake Village, CA 91362
PHONE (818)735-7876 EMAIL
CONTRACTOR'S NAME OWNERBUILDER? OYESZNO
BUSINESSNAME A-Avis Plumbing Heating&Air
ADDRESS 600 E Valley Blvd Colton, CA 92324
PHONE (909)825-3600 EMAIL
CONTRACTOR'S STATE LIC NUMBER 630503 LICENSE CLASSIFICATION C20
VALUATION$ $9,995-00 SQ FT L SO FT
APPLICANT'S SIGNATURE DATE 09/19/2016
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP I I
INVO ICE I I PAID AMOUNT 0 CASH 0 CHECK# CREDIT CARD VISA/MC
AMOUNT
PLAN CHECK FEES PAID AMOUNT 0 CASH 0-CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER () YES C 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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