PMT16-03310 City of Menifee Permit No.: PMT16-03310
29714 HALIN RD.
't;kCCELA_> MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 10/0712016
P E R M I T
Site Address: 31128 GREEN FOREST DR, MENIFEE, Parcel Number: 372-014-015
CA 92584 Construction Cost: $1,900.00
Existing Use: Proposed Use:
Description of REPLACE FAILI IN HALL CLOSET
Work:
Owner Contractor
ARLENE ORTIZ TRUTEAM OF CALIFORNIA INC
31128 GREEN FOREST DR 260 JIMMY ANN DRIVE
MENIFEE,CA 92584 DAYTONA BEACH, FIL 32114
Applicant Phone:3863042222
EDWARD PONCE License Number:221517
TRUTEAM OF CALIFORNIA INC
260 JIMMY ANN DRIVE
DAYTONA BEACH, CA 32114
Fee Description PA Amount
Forced-Air or Gravity-Type Furnace or Burner 1 149.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Mechanical 1 7.45
$184.45
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications orfrom preventing builiding operations being carried on thereunderwhen 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.
AkUdg_Pernnit—Template.ript Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or Improves thereon,and who contracts for the projects
I hereby affirm u rider penalty of perjury that I am under provisions of with a licensed contmctor(s)pursuant to the Contoctors State License Law).
Chapter!)(commencing vidth section 7000)of Division 3 of the Business and a I am exempt from licensure under the Contractoes State License Law for
Professions Code and my license is in full force and effect. the followmg reason:
License Class Z-z� Licen /Z By my signature below I acknowledge that,except for my personal residence
Expires 2/3 a/f 7 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 constnicted in its entirety by
ci I hereby affirm under penalty of perjury one of the following clecla rations:I licensed contractors.I understa nd that a copy of the applIca ble 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.IeRinfo.ca.gov/caIaw.html.
Policy# Date
�p have and will maintain worker's compensation insurance,as required by PROPERTY OWNERbR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work forwhich ci 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 146-- A-14 if r 't building construction.I authorize representatives of this city or county to
Policy# &)L K c 1Y 7,FAr n i yr) Expires 6 6C2 12,,/I enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred ,_-0e _Date ID//71Z
dollars($100)or less ER OR AUTHORIZED AGENT
o I certify that In the performance of the work for which this permit Is issued,
Ishallnotemplo any persons in any manner so as to become subject to the CITY BUSINESS LICENSE It
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workees compensation provisions of Section 3700 of the Labor
Code,I shall forthw' compi rovisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date 101711 mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0 Yes "o
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 req uIre a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQM D)?See permitting checklist
IN SECrION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY u Yes d/wo
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) 0 Yes 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 material reporting.
checkmark(s)I have placed next to the a pplicable item(s)(Section 7031.5 ciYes
Business and Professions Code).Any city or county that requires a perm it to !��. Date /0
construct,alter,improve,demolish or repair any structure,priorto 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 IRRP)
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-certified firms and comply with
an Applicant 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 themselves or through their
in 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 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 u 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 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 because:
o 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 please fill out the RAP
Acknowledgement
& SAFETY PERMIT/PLAN CHECK APPLICATION
A.
-A Menifee
DATE 10/07/2016 PERM IT/PLAN CHECK NUMBER
TYPE: F-ICOMMERCIAL [Z]RESIDENTIAL E]MULTI-FAMILY []MOBILEHOME [-]POOL/SPA [-]SIGN
SUBTYPE: F]ADDITIONE]ALTERATION F]DEMOUTION F]ELECTRICAL [-]MECHANICAL
E]NEW [:]PLUMBING F-IRE-ROOF-NUMBEROF-SQUARES_
DESCRIPTION OF WORK Replace FAU in hall closet.(100KBTU)
PROJECTADDRESS 31128 Green Forest Or
ASSESSOR'S PARCEL NUMBER 372-014-015 LOT 95 TRACT A28090
PROPERTY OWNER'S NAME ArteneOrtiz
ADDRESS 31128 Green Forest Dr, Menifee,CA92584
PHONE (830)237-7669 EMAIL
APPLICANT NAME Edward Ponce
ADDRESS 475 Rivera St,Ste:D, Riverside, CA92501
PHONE (951)722-6905 EMAIL
CONTRACTOR'S NAME TrutearnofCAInc OWNER BUILDER? E]YESW]NO
BUSINESS NAME
ADDRESS 475 Rivera St,Ste:D, Riverside,CA92501
PHONE (951)683-4429 EMAIL
CONTRACTOR'S STATE LIC NUMBER 221517 LICENSE CLASSIFICATION C20
VALUATION$ $1,900-00 SO FT L SO FT
APPLICANIT'S SIGNATURE DATE 10/07/2016
DEPARTMENT DWRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN log SMIP
INVOICE I PAIDAMOUNT
AMOUNT 1 0 CASH 0 CHECK# OCREDITcARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER 0, YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofiTIenifee.us Inspection Request Line-951-246-6213
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