PMT16-03325 City of Menifee Permit No.: PMT16-03325
29714 HAUN RD. Type: Residential Mechanical
44�CCE� MENIFEE,CA 92586
MENIFEE Date Issued: 1011112016
P E R M I T
Site Address: 33300 WILD LILAC RD, MENIFEE, CA Parcel Number: 384-050-021
92584 Construction Cost, $7,472.00
Existing Use: Proposed Use:
Description of REPLACE 3-TON HVAC PACKAGE UNIT
Work:
Owner Contractor
PHIL KILLINGREY AIR FORCE ONE HEATING AND AIR INC
33300 WILD LILAC ROAD 31566 RAILROAD CANYON ROAD
MENIFEE, CA 92584 #682
Applicant Phone:95124409116
MITCH BLUMAN License Number.955952
AIR FORCE ONE HEATING AND AIR INC
31566 RAILROAD CANYON ROAD
#682
CANYON LAKE, CA 92587
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 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_Bldg_Pemit Templatarpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION propertywho 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 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:
License Class_(_20 UcensgNo. 1955qf5-2- By my signature below I acknowledge that except for my personal residence
Expires 5/311 PIS SignatureW*/,G� in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot lega Ily 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
o I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applim ble law,Section
have and will maintain a certificate of consent of self-insum 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.Ieginfo.ca.goy/caIaW.I1tmL
Policy# Date
14`1 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 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
Carrier 14—a pu)bt C U;1 Je-etAl-ee S with all applicable city and county ordinances and state laws relating to
t building construction.I authorize representatives of this city Or county to
Policy#AlViC101 2-3-600 Expires t 0/ 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
a 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#
workees compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
I mixture containing a hazardous material equal to or greater that the
Applicant —Date �nh/16, amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS 0yes "a
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
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY ci Yes a No
I hereby affirm that under the penalty of perjury them 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 eNo
OWNER BUILDER DECLARATIONS I haw 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 a in 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.
checkmark(s)I have placed next to the applicable ftem(s)(Section 7031.5 0yes 0 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 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 rental property owners and property
than($SOD). managers who do the paint-disturbling work themselves or through their
o 1,as owner of the property,or my employee with wages as their sale employees.For more information about EPXs Renovation Program visit:
compensation,will do( I all of or( I portion of the work,and the structure is www.epa.gov/Jead 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:
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. o No EPA Lead-Safe Certified Firm is required for this project because:
ci 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 RRP
Acknowledgement.
I--
4,6
DATE !0jn ( ( (0 PERMIT/PLAN CHECK NUMBER
TYPE: F]COMMERCIAL C�(RESIDENTIAL MMULTI-FAMILY []MOBILEHOME EJPOOL/SPA []SIGN
SUBTYPE- nADDITION F]ALTERATION []DEMOUTION DELECTRICAL []MECHANICAL
E]NEW []PLUMBING []RE-ROOF-NUMBEROFSCIUARES— 'It,-I
d" "Wly )ept.
DESCRI PTION OF WORK VQ-O&r-e ��kocc,%e- Ov�,,+ +0 vl� Bull ing 8,
L/ OCT 11 2016
3
PROJEcTADDRESS =�-500 wzk� L-� -n-C f2,8 v E d
ASSESSOR'S PARCEL NUMBER Stq� 4060 - LOT TRACT
PROPERTY OWNER'S NAME fkrj,'k I-C�I
ADDRESS 33300 W � I � Lit&c j?,ALJ MS---,1% (ee C-N 0115V
PHONE (-?ILI)Al-1 - '60 3-1 — EMAIL
APPLICANT NAME 1,,Av�c�-,
ADDRESS 31 :�,Z5 L-A- 2,13 ljK5*kc,,Ice CC, qjqk-�-
U
PHONE 1Tj<r- '7-35--7T-7 (0 EMAIL
coNTRAcrowsNAME 1�01C �04U_ Ong OWNERBUILDER? [JYES[MNO
BUSINESS NAME A,,r �Or Le
ADDRESS 'S 6 (2_et�k rok�
EMAIL
PHONE - '2-44 - L
CONTRACTOR'S STATE LIC NUMBER 7, LICENSE CLASSIFICATION IS -4,0
VALUATION $ '-I, LJ-12- SQ FT L SO FT
APPLICANT'S SIGNATURE DATE—jOL( Ilko
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE
AMOU T PAID AMOUNT 0 CASH 0 CHECK# OCREDITCARD VISAIMC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREWCARD VISAINIC
LOWNER 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 951-572-6777
www.citVoI`menifee.us Inspection Request Line 951-246-6213
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