PMT16-03434 City of Menifee Permit No.: PMT16-03434
29714 HAUN RD. Type: Residential Mechanical
<A—CCELA—> MENIFEE. CA 92586
MENIFEE Date Issued: 1011912016
P E R M I T
SiteAddress: 28195 DAKOTA DR, MENIFEE, CA 92587 Parcel Number: 350-052-019
Construction Cost: $8,000.00
Existing Use: Proposed Use:
Description of REPLACEMENT OF FAU&AIC 80%BTU, 3 TON
Work:
Omer Contractor
LEO MARTINEZ WEST COAST APPLIANCE SERVICES INC
28195 DAKOTA DR 1256 FAYETTE STREET
MENIFEE, CA 92587 EL CAJON, CA 92020
Applicant Phone:6195570446
LEO GENDELIMAN License Number: 810930
WEST COAST APPLIANCE SERVICES INC
1256 FAYETTE STREET
EL CAJON, CA 92020
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 Bidg_Pe"It—Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improv,es 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 a in exempt from licensure under the Contractor`5 State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class G'(0 License No. By my signature below I acknowledge that except for my personal residence
Expires 07A I/ 19 -Signature 7E� in which I must have resided for at least one year priorto 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
o I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applica ble law,Section
have a nd will ma Inta In 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 I ndustria I Relations as provided for this application is submitted or at the following website:
by Section 3700 of th a Labor Code,for the performa nce of work for which www.leRInfo.ca.goy/calaw.htmI.
this permit is issued.
Policy# woqfwl��� Date
d4ave and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 ofthe Labor Code,for the performance ofthe work for which a By mysignature below I certilyto each ofthe following:I am the property
this permitis 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 Cle-A-1k,i T-r—
with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives ofthis city or countyto
policy#L-Cooig/09 6 6 Expires V?
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 work for which this permit is issued,
I shall not emol any persons In any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that ifl should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's cogLpensation provisions of Section 3700 of the Labor
Code,I shall forthwit cagotwith 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 Date amounts specified on the Hazardous Materials Information Guide?
AARNING-FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS �Yes a No
UNLAWFUL,AND SHALLSUBJECTAN EMPLOYERTO CRIMINAL PENALTIES Will the Intended use ofthe building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permitfor the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR CoastAir Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguldelines
CONSTRUCTION LENDING AGENCY ci-Yes o No
I hereby affirm that underthe penalty of perjury there is a constrtiction Will the proposed building or modified facility be within 1000 feet ofthe
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) &<5 a 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 99 rting.
checkmark(s)I have placed next to the applicable item(s)(Section 7MI.5 bylrs 0 No
Business and Professions Code).Any city or county that requires a permit to Efate
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(RRPI
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 be or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978
a nd the basis for the a lleged 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($500). managers who do the paint-disturbing work themselves or through their
o 1,as owner of the property,or my employee with wages as their sole am ployees.For more information about EPA!s RenovatIon P rognan visit:
compensation,will do( )allofor( )portion ofthe work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an ownerofa ci An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improve$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. ci 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 Contractoes State License Law does not apply to an owner of a Ifyour project does not comply with EPA RRP role please fill out the RRP
Acknowledgement.
3ity of Menifee
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION Dept.
Menifee OCT 19 2016
DATE 10/13/2016 PERMIT/PLAN CHECK NUMBERTM&�D1594V4
TYPE: []COMMERCIAL [ZIRESIDENTIAL E]MULTI-FAMILY [:]MOBILEHOME [:]POOL/SPA [-]SIGN
SUBTYPE: [-]ADDITION [-]ALTERATION []DEMOLITION DELECTRICAL [21MECHANICAL
[-]NEWE]PLUMBING F1 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK REPLACEMENT OF FAU&A/C,80% BTU,3TON
PROJECTADDREss 28195DAKOTADR
ASSESSOR'S PARCEL NUMBER �6 C)DV P 015 LOT TRACT
PROPERTY OWNER'S NAME LEOMARTINEZ
ADDRESS 28195 DAKOTA DR MEN IFEE,CA 92587
PHONE (951)553-3215 EMAIL fb.weas@gmall.com
APPLICANTINAME LECIGENDELMAN
ADDRESS 1256 FAYETTE ST EL CAJON CA 92020
PHONE (619)557-0446 EMAIL fb.wcas@gmail.Gom
CONTRACTOR'S NAME ALEX PODKOZHURNIKOV OWNERBUILDER-> 0YESZNO
BUSINESSNAME WESTCOASTSOLAR
ADDRESS 1256 FAYETTE ST EL CAJON CA 92020
PHONE (619)557-0446 EMAIL fb.wcas@gmail.com
CONTRACTOR'S STATE LIC NUMBER 810930 LICENSE CLASSIFICATION C10. C20
VALUATION$ $8,000-00 SO FT 1430 L SQ FT
APPLICANT'S SIGNATURE DATE 10/13/2016
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION SM,p CITY OF MENIFEE BUSINESS LICENSE NUMBE
BUILDING PLANNING ENGINEERING FIRE 7GREEN I octo
INVOICE � j2Aq.(0j PAIDAMOUNT I
AMOUNT I I OCASH OCHECK# -CREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT I I OCASH OCHECKM OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO OLNUMBER NOTARIZED LETTER 0' YES 0 NO
City of Menifte Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.citVofmenifee.us Inspection Request I ine 951-246-6213
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