PMT16-04229 City of Menifee Permit No.: PMT16-04229
29714 HAUN RD. Type: Residential Mechanical
<A_CCELA_> MENIFEE, CA 92586
r�_t Wk—, MENIFEE Data Issued: 12119/2016
P E R M I T
Site Address: 28571 BROADSTONE WAY, MENIFEE, Parcel Number: 340-111-003
CA 92584 Construction Cost: $9,200.00
Existing Use: Proposed Use:
Description of HVAC REPLACEMENT, 4 TON AIC(BACKYARD)90,000 BTU FURNACE(CLOSET)
Work:
Owner Contractor
EDGAR ORTIZ W C HEATING&AIR CONDITIONING INC
28571 BROADSTONE WAY 41085 GOLDEN GATE CIR
MENIFEE, CA 92584 MURRIETA, CA 92562
Applicant Phone:9516000700
JILL WESTON License Number.779604
W C HEATING&AIR CONDITIONING INC
41085 GOLDEN GATE CIR
MURRIETA, CA 92562
Fee Description ON 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 othervAse 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_Penft_TeMpIate.rpt Page 1 of 1
CITY OF MENIFE15
LICENSED DECLARAHOM 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 secrion 7000)of Division 3 of the Business and 0 1 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 r,*A LlcenseNo. TIR kia— By my signature below I acknowledge that,except for my personal residence
Expires (a Signature �\AU t6_6AQy0 in which I must have resided for at least one year prior to completion of
0 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 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.
Policy H Date
Y-i haveandwill maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
�ectlmi 3700 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 Policy owner or authorized to act on the property owner's behalf.I have read this
number are: application and the inforimation I have provided is correct.I agree to comply
With all applicable city and county ordinances and state laws relating to
Carrier VvO Ir lK d4re' building construction.I authorize representatives of this city or county to
Policyn OCAOUIOM-15 Expires 1 1 1!:7 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
ci I certify that in the performa nce of the work for which this permit is issued,
Ishallnotemplo any persons in any manner so as to become sUbjectto the CITY BUSINESS UCENSE# 0236.-�09,
worker's compensation laws of California,and agree that If I should become 14AZARDOUS 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
Applicant Date zi-i L mixture containing a hazardous material equal to or greater that the
��A ' 0 amounts specified on the Hazardous Materials Information Guide?
WARNING:FAVURE TO SECURE WORKERS COMPENSATION COVERAGE IS Oyes "
UNLAWFUL,AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TOONE HUNDREDTHOUSAND DOLLARS($11)(0,00D),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(SCALQMD)?See permitting checklist
IN SECFION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forgifidelines
CONSTFILICTION LENDING AGENCY o Yes "o
I hereby affirm that under the pena Ity of perjury there is a construction Will the proposed building or madified 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 ?Wo
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 CalifinmN 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 70315 oYes cMo
Business and Professions Code).Any city or county that requires a permit to Wk'% L� �36Adpn�. Date
construct,alter,improve,demolish or repair any structure,prior to its PROPEfV-OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permit to file a s igned statement
that he or she is licensed pursuant to the provisions of the Contra ctoes State EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Section 70001 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-certillied firms and comply with
an Applicant for a permit subjects the applicant to a civil peria Ity 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 more 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.goy/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions I-SOD-424-LEAD(5323).
Code;The Contractoes 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 employee?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 bemuse:
o 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Sectlion 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 role please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
-Menifee
DATE 12/15/2016 PERMIT/PLAN CHECK NUMBERA--1nx-0!A9jQ?1
TYPE: F—ICOMMERCIAL [E]RE51DEN-nAL F]MULTI-FAMILY [:IMOBILEHOME [:]POOL/SPA 05IGN
SUBTYPE: DADDITION E]ALTERATION [JDEMOLITION []ELECTRICAL EMECHANICAL
FINEW F]PLUMBING F—IRE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK HVAC REPLACEMENT.4 TON A/C(BACKYARD)90K BTU FURNACE(CLOSET)
PROJECTADDRESS 28571BROADSTONEWAY ('Itv of Menifei
Building Dept
ASSESSOR'S PARCEL NUMBER 3AD -!I\\-00 LOT TRACT
PROPERTY OWNER'S NAME EDGAR ORTIZ DEC 16 201
ADDRESS 28571 BROADSTONE WAY, MENIFEE
PHONE (951)328-4992 EMAIL Kecelved
APPLICANTNAME JILLWESTON
ADDRESS 3645 RUFFIN RD 330-335 SAN DIEGO,CA92123
PHONE (619)384-6622 EMAIL
CONTRACTOWSNAME RUSSELLCOCHRAN OWNERBUILDER? [-]YESRINO
BUSINESSNAME WC PLUMBING,HEATING&AIR
ADDRESS 41085 GOLDEN GATE CIR MURRIETA,CA 92562
PHONE (951)600-0700 EMAIL
CONTRACTOR'S STATE LIC NUMBER 779604 LICENSE CLASSIFICATION C20
VALUATION$ $9,200-00 SQ FT 1867 L SO FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION U I Y U�MtNIFEL BUNIN�h LILEN5L NUMBLK
BUILDiNG PLANNING ENGiNEERiNG FiRE � GREEN SMIP )Q
INVOICE ' PAIDAMOUNT
AMOUNT 6C';04 .10 � I OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LEITER —1 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityoj`menifee.uj Inspection Request Line 951-246-6213
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