PMT16-03190 City of Menifee Permit No.: PMT16-03190
29714 HAUN RD. Type: Residential Mechanical
<A-CCIIEU� MENIFEE,CA 92586
MENIFEE Date Issued: 0912712016
P E R M I T
Site Address: 27056 ROCKWOOD ST, MENIFEE, CA Parcel Number: 335-411-026
92586 Construction Cost: $1,900.00
Existing Use: Proposed Use:
Description of REPLACE 60,000 BTU FAU ONLY IN SAME LOCATION
Work:
Owner Contractor
JAMES BACA TRUTEAM OF CALIFORNIA INC
27056 ROCKWOOD STREET 260 JIMMY ANN DRIVE
MENIFEE,CA 92586 DAYTONA BEACH, FL 32114
Applicant Phone:3863042222
ED PONCE License Number:221517
TRUTEAM OF CALIFORNIA INC
260 JIMMY ANN DRIVE
DAYTONA BEACH,CA 32114
Fee Description Qty Amount
Forced-Air or Gravity-Type Furnace or Bumer 1 149.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Mechanical 1 7.45
$184AS
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_l3ldg_Pemnit-Ternplate.rpt Page I of I
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 contractors)pursuant to the Contractors5tate 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 a nd my license is in hill force and effect. the following reason:
License Class C—'Zej Ucenseyo. 62 2).5- 7 By my signature below I acknowledge that,except for my personal residence
Expires 945a//7 —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 structure that I
WORKER'S COMPENSATION DECLARATION have built as a n owner-builder if it has not been constructed in its entirety by
o I hereby affirm under pena Ity 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 Sect-ion 3700 of the Labor Code,for the performance of work for which www.Ie-info.ca.Rov/caIa%v.htmI.
this permit is issued.
Policy# Date
)�Lhave 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 y my signature below I cerfifyto each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy Itiner or authorized to act on the property owner's behalf.I have read this
number are; application and the information I have provided is corrEd.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# 1_1Z e 417 k4 61 kO Expires ez 13o I -t 7 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date 717-6//7
dollars($100)or less PkOWERTY UWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
I shall not em play 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 compensation provislo ns of Section 3700 of the Labor
Code,I shall forthw- comp e provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant:=� Dat mixture containing a hazardous material equal to or grater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ci Yes o 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 F1 NES 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 for guidelines
CONSTRUCTION LENDING AGENCY a Yes o 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) o Yes o No
OWNER BUILDER DECLARATIONS I have rea d the Hazardous Material Information Guide and the SCAQM D
permitting checklist.I understand my requirements under th e 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 hazardous material reporting.
checkni I have placed next to the applicable item(s)(Section 7031.5 oYes o No
Business and Professions Code).Any city or county that requires a permitto Date
construct,alter,improve,demolish or repair any structure,priorto its PROPERTYOWNER 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 childca re facility to be RRP-cerfified 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 orthrough their
o 1,as owner 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 I )portion of the work,and the structure is www.epa.goyllead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80D-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. a No EPA Lead-Safe Certified Firm Is required for this pmject because:
o 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7G44,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 EVA RRP rule please flil out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
44 Wenifee
A di&I"EM"I"'?,
10
DATE 09/27/2016 PERM IT/PLAN CHECK NUMBER 0-31L
TYPE: EICOMMERCIAL [Z]RESIDENTIAL []MULTI-FAMILY [—]MOBILEHOME E]POOL/SPA []SIGN
SUBTYPE: E]ADDITION FIALTERATION F]DEMOUTION. [-]ELECT 1ICAL ffMECHANICAL
E]NEWE]PLUMBING El RE-ROOF-NUMBER OF SQUARES—
DESCRIPTION OF WORK Replace FAU only in same location.(60KEITU)LHA"ViArl ao4iFr�
PROJECTADDRESS 27056RockwoodSt
ASSESSOR'S PARCEL NUMBER 335-4111-026 LOT 26 TRACT 026048
PROPERTY OWNER'S NAME JamesKBara —
ADDRESS 27056 Rockwood St,Menifee,CA92586 Oil Of Menifnp.
Bulimm—gy ec Safety Dept.
PHONE (951)345-0298 EMAIL SEP 2 7 2016
APPLICANTINIAME EdwardPonce
ADDRESS 475 Rivera St,Unit:D,Riverside,CA92501
PHONE (951)722-6905 EMAIL edward.ponce@truteam.com
CONTRACTOR'S NAME TruteamofCAlnc OWNER BUILDER? E]YESS&O
BUSINESS NAME
ADDRESS 475 Rivera St,Unit: D,Riverside,CA 92501
PHONE (951)683-4429 EMAIL
CONTRACTOR'S STATE LIC NUMBER 221517 LICENSE CLASSIFICATION C20
VALUATION$ $1.900-00 -4 SQ FT 1200 LSQ FT
APPLICANT'S SIGNATURE DATE 09/27/2016
I "US'N'SS LICENSE NU MBER
CAS 0 CREDIT CARD VISA/MC
C ViS MC
DEPARTMENT DWRIBUTION CITY 0'M ENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN k- SMIP
INVOICE PAIDAMOUNT t4b OCASH OCHECK# OCREDITCARD VISA/MC
AMOUNT 18!A- q5
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
M R 0 YES 0 No
OWNER BUILDER VERIFIED C)YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department29714 Houn Rd.Menifee, CA 92586 951-672-6777
vvww.cityofmen1fee.us inspection Request Line 951-246-6213
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