Loading...
PMT16-04122 City of Menifee Permit No.. PMT16-04122 29714 HAUN RD. Type: Residential Mechanical <A—CCEU� MENIFEE,CA 92586 nsd— MENIFEE Date Issued: 12115/2016 P E R M I T Site Address: 27921 LEXINGTON CT, MENIFEE, CA Parcel Number. 335-091-014 92586 Construction Cost: $13,447.00 Existing Use: Proposed Use: Description of HVAC REPLACEMENT 3-TON PACKAGE UNIT AND ALL DUCT WORK Work: Owner Contractor KEN BUKOWSKI RKM HEATING AND AIR CONDITIONING 27921 LEXINGTON COURT 11801 PIERCE ST#200 MENIFEE, CA 92586 RIVERSIDE, CA 92505 Applicant Phone:9516569970 BETH KRENING License Number: 936726 RKM HEATING AND AIR CONDITIONING 11801 PIERCE ST#200 RIVERSIDE, CA 92505 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 bulliding 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 Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects I hereby affirm under penalty of perjurythat 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 C17d se is in full force and effect. the following reason: License Class LicenseAIo. By my signature below I acknowledge that except for my personal residence Expires :!!�//l in which I must have resided for at least one year prior to completion of Signature. I�Iylll 04 9,j� �11 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 ci I hereby affirm under pena Ity of perjury one of the following decla rations: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 website: by Section 3700 of the Labor Code,for the performance of work for which this permit is issued. www.leginfo.ca.gov/�law.htmi. Policy# Date ci I 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 permi it is is 7 ed.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this number a A application and the information I have provided is correct.I agree to comply Carrier with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy#,2!, 41 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 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 fbr"ith comply)up those provisions, Will the applicant or future building occupant handle hazardous material or a 0( =;51t Applicamt_ V!,2Z / Date C:��l �Z mixture containing a hazardous material equal to or greater that the A2&1��4 amounts specified an the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S C04PENSATION COVERAGE IS Dyes ONO 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 TOONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FO occupant require a permit for the construction or modification from South R Coast Air Quality Management District(SCAQMD)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY oYes ONO 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 perrormance of the work which this permit is Issued outer boundary of a school? (Section 3097 Civil Code) ciYes ONO OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of 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 nextto the applicable item(s)(Section 7031.5 Dyes a 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 permitto file a signed statement that he or she is licensed 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 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 than($500). required practices.This includes rental property owners and property managers who do the paint-disturbing work themselves or through their u 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 )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-SOD-424-LEAD(5323). Code;The Contractor's State License Law 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. n No EPA Lead-Safe Certified Firm is required for this project because: u 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. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION "Menifee DATE PERMIT/PLAN CHECK NUMBEqtMt OIJJQQI� TYPE: EI COMMERCIAL 2RESIDENTIAL E]MULTI-FAMILY E]MOBILEHOME []POOL/SPA [-]SIGN SUBTYPE: []ADDITION E]ALTERATION [-]DEMOLITION F]ELECTRICAL [-]MECHANICAL []NEW []PLUMBING F�RE-ROOF-NUM13ER OF SQUARES DESCRIPTION OF WORK f kw�� �60,) �- PROJECT ADDRESS 1eXah_,7),Aj 61' 1%U1,1Cee I-A Z,17— City of Menlfee ASSESSOR'S PARCEL NUMBER lywI- 0!31 !01 U LOT TRACT Building & Safety Dept. PROPERTY OWNER'S NAME nFc I s 2nis ADDRESS PHONE EMAIL o Heceived APPLICANT NAME 14E"t6 ADDRESS 6,� /�V :��t 14 PHONE 21L EMAIL CONTRACTOR'S NAME OWNERBUILDER? [_IYES2U�O BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ 0 /3 SO FT L SO FT APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION 6SINE_S�LFCEi�_E��i�EE� BUILDING PLANNING ENGINEERING FIRE GREEN SMIP X INVOICE PAID AMOUNT AMOU T ��qLA-10 I - CASH -CHECK# 0 CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT - I I -_ CASH 0 CHECK# CREDITCARD VISA/MC [OWNER 13UILDER VERIFIED OYES 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.cityofmenifee.us Inspection Request Line 951-246-5213 > 0 0 a 0 0 w w � M 6) 0 M > m m z SO 0 m w q @ 8, m m c m = M el 0 0 0 m z m m 3 0 1 z m 0 0 0 CL 0 0 r) m m 0 0 0 m MD m 0 ct n 0 0 w w 0- c- = o = n m > m 0 X z m m 0 0 m 0 M 3 c m > 6 m m (D M m m 0 m m M n m 6) 0 r) RL n =r 0 Ei, m < on m M M 4� m 0 0 0 0 N 0 3 CZ 0 m rr 0 0 0 0 0 60 w 0 < o :E 1E m o m m EL M, m n m 0 m m aq 0 c m 0 RL M m X 0 9 m rD m z m z M 0 cl 0 w m 0 m n ri 10 PC 0 0 n (D > 3 0 CID m M HkA i5i > z M m m n M I = — R 9 ,4 6 (D 0 m mo CL 0 z 1 m 0 3 99 0 0 0 FD' r) ' m n 0 Km . = :� a r) , 0 n 't, � 'L, , - RL m 3 x , ;RO , 8' Q. aq ZL I S ;a Si EL ErW �R a 3 x > m m . . . a m m 1E �l V ig ir u Ow n m RL al, RL :E 0 3 S 1E F3 0 CL n 5z 0 m m m no 0 Ln 0 z 0 m cr 0 0 FD' iu, FL n m Z � -S m w :E Cc) > A 0 0 M K 3 crZ 0 = ID 7z M 0 CA CL M ro 0 < M r) oz 'M ED ur rl M- M 0 ID 0 CL > a M CL EE E vi, ;w Z CA 0 n 2. M CA M 1� 0 Sr 0. 0 W 0 0 w CA 0 42 CA CA r, A 0 CA CA CA a =7 CA Q M CA CA CA Er n 3 5L 0 . - 6 - - - 0 0 r w 71 M 0 0- N g 0 on M 0 0 7- CL -- < M a q: 0 - E EL 01 :a !D M Er kb 0 vzm� rd a rri CA w IAO Wn ID ZW n Qw� M, 0 0 03 3 M at- 2 .2. CL 0 2 A 2 1 n CA r) a i3