PMT16-03146 City of Menifee Permit No.: PMT16-03146
29714 HAUN RD.
<—ACCECA—> MENIFEE, CA 92586 Type: Residential Mechanical
......tV, MENIFEE Date Issued: 09123/2016
P E R M I T
Site Address: 27765 WHISPERWOOD RD, MENIFEE, Parcel Number: 340-300-041
CA 92584 Construction Cost: $6,400.00
Existing Use: Proposed Use:
Description of HVAC REPLACEMENT 3 TON
Work:
Owner Contractor
SHEILA CALABRANO LUKE'S AIR CONDITIONING&HEATING
27765 WHISPERWOOD RD 1916 CENTURY AVE
MENIFEE, CA 92584 RIVERSIDE,CA 92506
Applicant Phone: 9097896562
ED LUKE License Number:594350
LUKE'S AIR CONDITIONING&HEATING
1916 CENTURY AVE
RIVERSIDE, CA 92506
Fee Description Qtv Amount M)
Forced-Air or Gravity-Type Furnace or Bumer 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 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 BidgPermit Template.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 pena Ity of perjury that I am under provislons of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter!)(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:
UcenseClass 6"-za Ucen5eAo. By my signature below I acknowledge that,except for my personal residence
Expires 20) Signature in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legallitsell a structure that I
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 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.IegInfiu.ca.gov/caIaw.htmI.
Policy# Date
ci I have and will maintain worker's compensation Insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which a 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 building construction.I authorize representatives of this city or county to
Policy# Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the perm it Is for one-hundred Date
dollars($100)or less PROPERTY OWN ER OR AUTHORIZED AGENT
I certify that in the performance of the work for which this permit Is issued,
I ski not em ploy any persons in any ma nner 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 compensatiio . ions of Section 3700 of the Labor
rovis
n V.
Code,I shall forthwith comply o isions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant&Q Date 7/2--a amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 0 Yes It'No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FIN ES 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 for guidelines
CONSTRUCTION LENDING AGENCY o Yes kNo
I hereby affirm that under the pena Ity 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) ciYes; e_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 exempt from the California Health&Safety Code Section 25505 and 25534 concerning
Contractoes License Law for the reason(s)indicated below by the hazardous a i r rti
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Ikes O'No!
Businessand Professions Code).Any city or county that requires a permitto
construct,alter,improve,demolish or repair any structure,prior to its zff —Date
PROPERTY OWNER OR AUfHORIZED 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 Contractoes State EPA RENOVATION,REPAIR AND PAINTING(FIRM
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-certifted firms and comply with
an Applica nt for a permit subjects the applicant to a civil penalty of not more required practices.This includes renta I property owners and property
than($500). managers who do the paint-disturbing work themselwas or through their
a 1,as owner of the property,or my employee with wages as theirsole 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.epe.gov/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 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:
sa le.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the bu rden of proving that it was
not built or improved for the purpose of sale. ri No EPA Lead-Safe Certified Firm is required for this project became:
ci 1,as owner of the property a rn 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 RRP rule please fil I out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
RMenifee
DATE -23-/4� PERMIT/PLAN CHECK NUMBER PrMto'.01!?l
TYPE: 0 COMMERCIAL A�RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION 0ALTERATION ODEMOLITION OELECTRICAL KIMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK aV?4-(
PROJECTADDRESS 72-265
ASSESSOR'S PARCEL NUMBER 3LIC-300 -Oqi LOT TRACT A5'M(P-I
OWNER NAME
ADDRESS 'Z-? )& 15 LADJ-t ) P6K,G0 00'0 k4
PHONE qq �- 3S-j - qjqj EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME LJZKE-�, )go Lai� W' OWNERBUILIDER? OYESONO
BUSINESS NAME
ADDRESS t
PHONE -)9 '3 EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ (Q!4 �,/SQ FT LSQFT
APPIL IE DATE 2
aTYSTAFFUSEONLY
CITY OF MENIFEE BUSINESS LICENSE NUMBER
DEPARTMENT DISTRIBUTION GREEN SMIP
BUILDING PLANNING ENGINEERING FIRE I
INVOICE PAID AMOUNT
AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 No DL NUMBER NOTARIZED LETTER 0 YES 0- NO
City of Menifee Building&Safety Department 29714 Hour) Rd. MeAifee, CA 92586 951-672-6777
www.cityofmenifee,Lis Inspection Request Line 951-246-6213
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