PMT16-03136 City of Menifee Permit No. PMT16-03136
29714 HAUN RD. Type: Residential Mechanical
<A-CC1ELA> MENIFEE, CA 92586
'qA- MENIFEE Date Issued: 09/22/2016
P E R M I T
Site Address: 30885 PERRINE ST, MENIFEE,CA 92586 Parcel Number: 472-020-017
Construction Cost: $1,450.00
Existing Use: Proposed Use:
Description of REPLACE A/C CONDENSING UNIT ONLY
Work:
Owner Contractor
MIKE SMITH AIR QUALITY SPECIALIST INC
1000 N STATE STREET P 0 BOX 105
HEMET, CA 92581 SAN JACINTO, CA 92583
Applicant Phone:9514876700
RON SMITH License Number: 929419
AIR QUALITY SPECIALIST INC
P 0 BOX 105
SAN JACINTO, CA 92583
Fee DescrIption ON Amount($)
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 6.65
$167.65
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 buillding 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.B1dg_Pe"lt-Temp1ate.rpt 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 u nder 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 licensure under the Contrzictor's State License Law for
Professions Code and my license is in full force and effecL the following reason:
License Class 2-C) License No.
By my signature below I acknowledge that,except for my personal residence
Expires ":2—�L? Signature in which I must have resided for at least one year prior to completion of
improvements covered by this permit I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
cr 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-insu re for worker's 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provid ad for this a pplication is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which www.leginfo.ca.gory/calaw.himil.
this permit is issued.
Policy# 46*0=!M�720 PROPERTY OWNER OR AUTHORIZED AGENT Date
o I have and will maintain worker's compensation insurance,as required by
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
C )4 ,Iv4,e, — building construction.I authorize representatives of this city or county to
arrierA Zlh&/1'7� I /,/ ,/t e with all applicable city and county ordinances and state laws relating to
A
Policy# /&Expires 1-14K—PF enter the above Identified property for inspection purposes.
(This section need not to be corn pleted is the permit is for one-hundred Date
dollars($100)or[us PROPERTY OWN ER OR AUTHORIZED AGENT
o I certify that in the performa nce of the work for which this permit is issued,
I shall not ern Ploy any persons in a ny manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compens . I f C [if ' HAZARDOUS MATERIAL DECLARATION
/ron aws c, :a orm and agree that If I should become
subject to the ker's c pensation ovisions of Section 3700 of the Labor
Code,I shal rthwith q I ose provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applican Date amounts specified on the Hazardous Materials Information Guide?
W W R NG. 'S COMPENSATION COVERAGE IS ciYes oNo
. ILU To S UR 0 S CO
AR NG:FAI URE TO SECURE WORKER'
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 ON E 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
CONSTRUCIION LENDING AGENCY a Yes ci No
I hereby affirm that under the penalty of perjury there Is a construction Will the proposed building or modified facility be within 1.000 feet of the
lending agency for the performance of the work which this Perm it is Issued outer boundary of a school?
(Section 3097 Civil Code) rr Yes ci 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 I am exam pt from the 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 pla ced nut to the applicable item(s)(Section 7031.5 ciYes u No
Business and Professions Code).Any city or county that requires a permit to Date
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 IRRPI
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 childmire facility to be RRP-certifted 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 owrier 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-gay/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 o 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 a re 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. a No EPA Lead-Safe Certified Firm is required for this project because:
o 1,as owner of the property am exclusively contracting with licensed
contmictorsto construct the project(Section 7044,Business and Professions
Code:The Contractoes 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
a a WAN a RAW I I Z Nor.,I 111MIll no WONVIAMMI 1[400 1 Lei 01
�"Menlfee
DATE -22 ,16 PERMIT/PLAN CHECK NUMBER
TYPE: �.� COMMERCIAL 91"RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA SIGN
SUBTYPE: CADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES 4-/c
DESCRIPTION OF WORK je-.,t_
City Ot I A
PROJECT ADDRESS I> _�_uilding
ASSESSOR'S PARCEL NUMBER LOT SEP 2 2 2§fF
OWNER NAME -4.4
ADDRESS ZeQa() _Z,/Z—� v ow psw
PHONE !7
EMAIL
APPLIrARIT RIARAC
ADDRESS dZ7 C4 LJL�� Z.7&,,�if
PHONE �2 iiL Q ry, C) �(40;_j
EMAIL
CONTRACTOR'S NAME �,I'C-Cl'4 0 YES ONO
BUSINESS NAME 14 1j,
ADDRESS
J� x,i
PHONE �7 EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION SO LSQFT
7-2-
APPLICANTS SIGNATUREgo�g DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION _M'kC F MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE � GREEN SMIP X
INVOICE � PAIDAMOUNT I
AMOUNT JUJ' (05 1 1 0- CASH OCHECK# CREDIT CARD VISA/MC
PLAN CHECK FEES I PAIDAMOUNT 0 CASH 0 CHECK 9 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED -_YES 0 NO DILNUMBER NOTAR1111)LETTER =
City of Menifee Building & Safety Deportment 29714 Haun Rd. Menifee, CA 92586 951-572-6777
wvvw_cityofmenif,Ee.tjs Inspection Request Line 951-246-5213
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