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PMT16-03349 City of Menifee Permit No. PMT1 6-03349 29714 HAUN RD. Type: Residential Mechanical <A-CCELX-> MENIFEE, CA 92586 MENIFEE Date Issued: 10112/2016 P E R M I T Site Address: 28852 E WORCESTER RD, MENIFEE, CA Parcel Number: 337-140-003 92586 Construction Cost: $1,800.00 Existing Use: Proposed Use: Description of REPLACE ALL DUCT WORK FOR HVAC SYSTEM Work: Owner Contractor BONNIE PHILLIPS W C HEATING&AIR CONDITIONING INC 28852 E WORCESTER ROAD 41085 GOLDEN GATE CIR MENIFEE,CA 92586 MURRI ETA, CA 92562 Applicant Phone:9516000700 JILL WESTON License Number: 779604 WC HEATING&AIR CONDITIONING INC 41085 GOLDEN GATE CIR MURRIETA, CA 92562 Fee Description Qtv Amount Building Permit Issuance 1 27.00 Inspections not specified 116 116.00 GREEN FEE 1 1-00 General Plan Maintenance Fee-Building 1 5.80 $149.80 The issuance of this permit shall not prevent the building official from thereafter requiring the correclion of errors in the plans and specifications or from preventing buillding 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.Bidg2ermit—Ternplate.rpt Page 1 of 1 CITY OF MENIFEIE 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 a 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 followhig reason: LicenseClass 0.10 LicenseNo. :1-Ig Ld� By my signature below I acknowledge that,except for my personal residence Expires (,(%61 IL Signature tVCQk, (6-6ACh'l) in which I must have resided for at least one year prior to completion of 0 improvements covered by this permit.I cannot legally SE11 2 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,Secrion have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Proliassions 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 websitv. by Section 3700 of the Labor Code,for the performance of work for which this permit is issued. wvvvv.IegJ[nfo.ca.gov1caIaw.html. Policy# Date PROPERTY OWNER OR AUTHORIZED AGENT p1l have and will maintain worker's compensation insurance,as required by 'section 370D 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 p.olicy owner or authorized to act on the property owner's behalf.I have read this numberare: application and the Information I have provided is correct I agree to comply Carrier MY V—Swure, with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy# 1J)CWU'1O5VV'1_Expires_ 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 performance of the woi&k for which this permit is issued, I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE If 0-3 o 9, worker's 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 mixture containing a hazardous material equal to or greater that the Applicant k1aL, Date iL amounts speCified an the Hazardous Materials Information Guide? WARNING-FVAURE TO SECURE WORKER'S COMPENSATION COVERAGE IS oYes " UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applica nt or Mure building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($10D'oucl),IN occupant require a permit for the construction or madifinfion from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist IN SECTION 370S OFTHE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines CONSTRUCTION LENDING AGENCY Dyes "o I hereby affinnin 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) a Yes ?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 Contractor's 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 OYes "o Business and Professions Code).Any city or county that requires a permit to Wk,li L' kLkA9__� Date construct,after,Improve,demolish or repair any structure,pdorto its PROPEFW—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 Busimess and Professions Code)or that he or she is exempt from licensum receiving compensation for most work that disturbs paint in a pm-1978 and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-cert1R2d 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($500). managers who do the paint-disturbling work themselves orthrough their a 1,as owner of the property,or my employee with wages as theirsole employees.For mom 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.gov/lead 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 Low does not apply to an owner of a o 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. 0 No EPA Lead-Safe Certified Firm is required for this project because: o 1,as owner of the property a in 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.