PMT16-03260 City of Menifee Permit No.: PMT16-03260
29714 HAUN RD. Type: Residential Mechanical
't;KCCI-70� MENIFEE,CA 92586
MENIFEE Date Issued: 1010412016
P E R M I T
Site Address: 26198 LANCASTER DR, MENIFEE, CA Parcel Number: 335-131-022
92586 Construction Cost: $1,800.00
Existing Use: Proposed Use:
Description of REPLACE 2.5-TON ROOFTOP PACKAGE UNIT
Work:
Owner Contractor
CHERYL CHRISTOPHER AIR QUALITY SPECIALIST INC
26198 LANCASTER DRIVE P 0 BOX 105
MENIFEE,CA 92586 SAN JACINTO,CA 92583
Applicant Phone: 9514876700
RON SMITH License Number.929419
AIR QUALITY SPECIALIST INC
P 0 BOX 105
SAN JACINTO. CA 92583
Fee Description Qtv Amount($
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 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 pemnit 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.
AABIdg-Permit Temp[ate.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 Lawfor
Professions Code and my license is in full force and eff the following reason:
License Class C U Lic e No. By my signature below I acknowledge that,except for my personal residence
Expires 0-aSignature 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
ci 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.Iegmfo.ca.Rov/caIaw,.htmI.
this permit is issued.
Policy# PROPERTY OWNER OR AUTHORIZED AGENT Date
ci I haw 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 am: application and the information[have provided is correct.I agree to comply
Canrler &�7--Iel�,-41 Z" e-1— with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
5-1
Policy# enter the above identified property for Inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the perfor e of the work for which this permit is issued,
I shall not employ any�Pe�nsln any manner so as to become subject to the CITY BUSINESS LICENSE#
nt I'
workees compensa aws of California,and ee that If I s ou become HAZARDOUS MATERIAL DECLARATION
s bject to the r,s com s n provis' s of Section 3700 o the Labor
u�J, 0 wit Will the applicant or future building occupant handle hazardous material or a
Code 11 sh o with co se isians.
AppficZE Z Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
A WA4RNG.:LFAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ci Yes ci No
L U
UNLAL UIL,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 PROVID-ED 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 ciYes oNo
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) oYes oNo
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 material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ciYes a 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 Contra ctoes 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 p re-1978
and the basis for the a Ileged exern ption.Any violation of Section 7031.5 by residence or ch ildcare facility to be RRP-certified firms a nd com Ply 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 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 I )all of or I )portion of the work,and the structure is www.epagov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-BOD-424-LEAD(5323).
Code;The Contractoes 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:
Certified Firm Na m e:
sale.If,however,the building or improvement is sold within one year of Certification No
Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
.r
not built or improved for the purpose of sale. o No EPA Lead-Safe Cerntified Firm is required for this project bemuse.,
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 RRP rule plew fill out the RR
Acknowledgement-
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
"'Wenifee
DATE /0 - PERM IT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL 04ESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: 0 ADDITION 0 ALTERATION 0 DEMOLITION 0 ELECTRICAL C>4ECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES-
DESCRIPTION OF WORK &4&�Cz da, y.4
Lz4r
PROJECTADDRESS 11o9),Vcf,4-dr7X at
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
C 0
ADDRESS lfc,"AwIldiA
PHONE EMAIL eff 4 2016
APPLICANT NAME
ADDRESS Roceived
PHONE EMAIL
CONTRACTOR'S NAME 4-1 -C-' _5;le'wC ,A/.0AX4R BUILDER? 0 YES e-N0
BUSINESS NAME 6141, s-eee/lz-
ADDRESS lll�VO /j// XJ� IL C,��/ I)- i/ �,
PHONE J'j yof-'71 J� EMAIL 34 1�' C_67_z�
CONTRACTOR'S STATE LIC NUMBER 9 LICENSE CLASSIFICATION
VALLIAMN Al LSQFT
1p 4�:eg z
A
APPLICANT'S SIGdltRE_Z,�A�t DATE
MENIFEE BUSINESS LICENSE NUMBER
DEPARTMENT DISTRIBUTION
BUILDING PLANNING ENGINEERING FIRE I GREEN k SMIP
INVOICE PAID AMOUNT
AMOUNT 10 1 1 IOCASH OCHECK# CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
[OWNER BUILDER VERIFIED OYES 0 No DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of IvIenifee 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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