PMT16-04012 City of Menifee Permit No.! PMT16-04012
29714 HAUN RD. Type: Residential Mechanical
<A—CCr=Li;> MENIFEE, CA 92586
MENIFEE Datelssued: 12108/20ill
P E R M I T
Site Address: 27213 COMWELL ST, MENIFEE,CA Parcel Number: 335-331-001
92586 Construction Cost: $2,200.00
Existing Use: Proposed Use:
Description of REPLACE HVAC PACKAGE UNIT ON ROOF
Work:
Owner Contractor
DENNISCRAKER AIR QUALITY SPECIALIST INC
27213 COMWELL ST 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 Pti 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 emors 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 vOthin 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.BidgPemit-Template.rpt Page I of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves themon,and who contracts for the projects
with a licensed cantractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter!)(commencing with section 7000)of Division 3 of the Business and a I am exempt from ficensure under the Contractor's State Uicense Law for
Professions Code and my license is in full force and effect. the following reason:
I
License Claw 4L 2-6) U mpe No. By my signature below I acknowledge that,eiicept for my personal residence
Expires —30—I, k Signature in which I must have resided for at least one year prior to completion of
41LX�4� Improvements covered by this permit.I cannot legallysell a stnicture that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed In its entirety by
u 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 web5ite:
by Section 3700 of the Labor Code,for the performance of work for which www.leginfa.ca.gou/calaw.irml.
this permit is issued.
policylt 4ftgtv�mv— � PROPERTY OWNER OR AUTHORIZED AGENT Date
a 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 cr By my signature below I certify to each of the following:I am the property
this permit is issued.My workees compensation insurance carrier and policy owner or authorized to act on the property omer's behalf.I have read this
number are. application and the information I have provided is correct.I agree to comply
/,,�6;/,-h �r with all applicable city and county ordinances and state laws relating to
Carrier t llv4y-' building construction.I authorize representatives of this city or county to
Poficy# Pines enter the above Identified property for inspection purposes.
Z&ExI -
(This section need not to be completed is the permit is for onE-hundred Date
dollars($100)or less PROPERTY OWN ER OR AUTHORIZED AGENT
D I certify that in the performance of the work 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 N
worker'scompens on laws of Californ'll and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the er's pensation ovisions ol'Section 3700 of the Labor
Code,I shal rthwit b I ose provisions. Will the applirant or future building occupant handle hazardous material or a
Applican Date mixture containing a hazardous material equal to or greater that the
a mounts specified an the Hazardous Materials Information Guide?
WAR Nr-FAT,I IRE TO SECURE WORKEWS COMPENSATION COVERAGE IS ciYes ciNo
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 require 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 SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidellnes
CONSTRUCTION LENDING AGENCY a Yes o No
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 3D97 Civil Code) crYes ciNci
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 eiiempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contraictoes License Law for the reason(s)Indicated below by the hazardous material reporting.
checkMaTk(s)I have placed next to the applicable item(s)(Section 7031.5 oYes a No
Business and Professions Code).Any city or county that requires a permit to Date
construct,a[ter,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 ficensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRP)
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 Hcensure 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 resid ence or childca re ft cility to be RRIi-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
ci 1,as owner of the property,or my employee with wages as their sole 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 wwwepa.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 ci An EPA Lead-Saft,Certified Renovator will be responsible for this project
property who,through employeo'or personal effort,builds or improves the
property provided that the improvements a re 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-Buflder will haw the burden of proving that it was
not built or improved for the purpose of sale. a No EPA Lead-Safe Certified Firm is required for this pmject because:
ct 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 RAP rule plesse fill out the RRP
Acknowledgement
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
g-Menifee
DATE -7 - A, PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL 0-IrESIDENTIAL OMULTI-FAMILY 0- MOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION 0ALTERATION ODEMOLITION OELECTRICAL G-IvrECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
b4
DESCRIPTION OF WORK e;'1V
PROJECTADDRESS 2-1 3, 10 z�
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME De 4,QZ C414A611—
ADDRESS -6
PHONE EMAIL
APPLICANT NAME A
ADDRESS *lid �,5-y"7
PHONE 7 2e)V EMAIL
CONTRACIFOWS NAME aL/Izj C,If q: OWNER BUILDER? 0 YES 0416
BUSINESS NAME
ADDRESS
jile4- liq
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER
6//a LICENSE CLASSIFICATION Otb
"VALUATION$ SQ FT L SQ FT
A C
PPLIOANT'S SIGNATURE 141-VA 7� DATE 12-- 7—
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP I I
= 1 .10 � PAID AMOUNT 0 CASH 0 CHECK# OCREDITCARD VISAIMC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# 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 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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