PMT17-00343 City of Menifee Permit No.: PMT17-00343
29714 HAUN RD. Type: Residential Mechanical
�!-�CCEL%\ MEN]FEE,CA 92586
MENIFEE Date Issued: 02/06/2017
PERMIT
Site Address: 29305 CHAMPION CT, MENIFEE, CA Parcel Number: 338-183-014
92586 Construction Cost: $10,093.00
Existing Use: Proposed Use:
Description of REPLACE 60.000 BTU FURNACE,3 TON(16 SEER)A/C UNIT&COIL
Work:
Owner Contractor
MARIAN MILLER PEACH HOME SERVICES INC
29305 CHAMPION CT 532 MALLOY COURT
MENIFEE, CA 92586 CORONA,CA 92880
Applicant Phone:7144628174
JANE RECKTENWALD License Number: 1018348
PEACH HOME SERVICES INC
532 MALLOY COURT
CORONA,CA 92880
Fee Description Qtv Amount($
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_Bldg Perrnit_Templale.rpl Page 1 of i
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
1 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 am exempt from licensure underthe Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class C c-L0P5tD License No. By my signature below I acknowledge that,except for my personal residence
Expires-5D- l k Signature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
have built as an owner-builder H it has not been constructed in its entirety by
❑I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that 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.eov/calaw.html.
Policy ft
Date
y11have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which D By my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: application and the information I have provided is correct.1 agree to comply
A,_ u k with all applicable city and county ordinances and state laws relating to
Carrier ffCC�Yf v`O�rrr N�KA building construction.I authorize representatives of this city or county to
Policy tt �MR'430b� Expires enter the above identified pr pd y 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 AUlbbRIZED AGENT
❑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 -'2JS�la
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith compIVIR those provisions. �1 Will the applicant or future building occupant handle hazardous material or a
Applicant Datep��o-1 1 mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO 6t4ii WORKER'S COMPENSATION COVERAGE IS ❑Yes Saff0
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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY 0 Yes "(f 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 3097 Civil Code) o Yes o
OWNER BUILDER DECLARATIONS I have red the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that am exempt from the permitting checklist.I understand my requirements under the State of
California Health
Contractors License Law for the reason(s)indicated below by the Bit Safety Cade,Section 25505 and 25534 concerning
hazardousmdaterial reporting.
checkmark(s)I have placed nextto the applicable Kern(s)(Section 7031.5 oyes �J
Business and Professions Code).Any city or county that requires a permit to Date o1-tv- s f
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUT R AGENT
issuance,also requires the applicant forthe permitto file a signed statement
that he or she Is licensed pursuant to the provisions of the Contractors 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
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
0I,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( )all of or( )portion of the work,and the structure is www.epa.eov/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 Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible forthis 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:
01,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors 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.
AR
DATE PERMIT/PLAN CHECK NUMBER
TYPE: COMMERCIAL PRESIDENTIAL MULTI-FAMILY J MOBILE HOME POOL/SPA Ci SIGN
SUBTYPE: ADDITION , ALTERATION F>DEMOLITION c ELECTRICAL •MECHANICAL
" NEW , PLUMBING v RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Replace 60,000 btu furnace, 3 ton (16 seer) A/C unit & coil
PROJECTADDRESS 29305 Champion Ct Menifee, CA 92586
ASSESSOR'S PARCEL NUMBER 338-183-014 LOT 3 TRACT /1(DLf
OWNER NAME Marian Miller
ADDRESS 29305 Champion Ct Menifee, CA 92586
PHONE 951-834-3428 EMAIL
APPLICANT NAME Jane Recktianwald
ADDRESS
PHONE 714-336-6159 EMAIL net
CONTRACTOR'S NAME Walton's Heating & Alr OWNER BUILDER? D YES VNO
BUSINESS NAME
ADDRESS 532 Malloy Crt Corona CA 92880
PHONE 951-737-4141 EMAIL
CONTRACTOR'S STATE LIC NUMBER 1018348 LICENSE CLASSIFICATION C20 C36
VALUATION $ 10 ICA-6.00 SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE_-2-6-17
DEPARTMENT DISTRIBUTION � CITY Of MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE '0 PAID AMOUNT
AMOUNT '.% CASH '%CHECK p ='CREDIT CARD VfSA/MC
PLAN CHECK FEES PAID AMOUNT ) CASH ii CHECK# "CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED YES NO DL NUMBER NOTARIZED LETTER C YES C' NO
LI'7 ;Pn 7iri Lh;u nq <.i,Ti, ,, I'UUa:' "d. i ri4c CA "_I.'6 951-6/2-5777
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