PMT17-00401 City of Menifee Permit No.: PMT17-00401
29714 HAUN RD.
�CCEL/� MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 02/13/2017
PERMIT
Site Address: 27332 CABRILLO DR, MENIFEE, CA Parcel Number: 336-201-002
92586 Construction Cost: $2,000.00
Existing Use: Proposed Use:
Description of REPLACE ALL DUCT WORK
work:
Owner Contractor
DAVID VALLES ACCU HEATING AND AIR CONDITIONING
27332 CABRILLO DRIVE P 0 BOX 973
MENIFEE,CA 92586 WILDOMAR, CA 92595
Applicant phone:9516234266
JASON KIRKISH License Number:963185
ACCU HEATING AND AIR CONDITIONING
P O BOX 973
WILDOMAR, CA 92595
Fee Description Oty Amount i$1
Building Permit Issuance 1 27.00
Inspections not specified 116 116.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 5.80
$149.80
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 carded on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise staled,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_Pennit_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 perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter!)(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License Law for
Professions Cade and my license is in full force and effect. the following reason:
License Class C^ Z License N % (a_3 By my signature below I acknowledge that,except for my personal residence
Expires 7 .3< 17 Signature in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATIOI have built as an owner-builder If K 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 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 webs#e:
by Section 3700 of the Labor Code,for the performance of work for which
www.leeinfo.ca.¢ov/calaw.html.
this permit is issued.
Policy# Date
D 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 ❑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 information I have provided is correct.1 agree to comply
with all applicable city and county ordinances and state laws relatingto
Carrier building construction.I authorize representatives of this city or county to
Policy If 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
1 certify that in the performance of the work for which this permit is Issued,
I shall not emnioy any persons In any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if 1 should become HAZARDOUS MATERIAL DECLARATION
subject to the workers 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 2-iJ^�7 mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNIN JAIL RE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0 Yes �o
UNLAWFU D 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($300,000),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 37060F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY o Yes %FN'o
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) 0 Yes ,rPWP
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
Contractor's License Law for the reason(s)indicated below by the California at
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 �hc azardrial reporting.
Business and Professions Code).Any city or county that requires a permit to [ores o
ou material
al Safety Code,Section 25505 and 25534 concerning
n
Date <'«-1-7
construct,alter,improve,demolish or repair any structure,priortoits PR ERTYOWNER 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 ENO ATION 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 required practices.This Includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
0 I,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.eO La�g_ov/lead/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 ❑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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑I,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.
ii SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE 2 / �j / PERMIT/PLAN CHECK NUMBER 4n
TYPE: 0 COMMERCIAL RESIDENTIAL O MULTI-FAMILY C MOBILE HOME O POOL/SPA G'SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL ?KMEEC . 1kAi MOrifto
ng & Safety Dept
B
O NEW O PLUMBING fl RE-ROOF-NUMBER OF SQUARES UVA
DESCRIPTION OF WORK FEB 13 2017
Ree
PROJECTADDRESS �� 3J G� b(Ll �� e1 ei
ftd
ASSESSOR'S PARCEL NUMBER 33C,41 -,:).6 (-00aOT TRACT
OWNER NAME �- L(ntL& -zi(- ��t-e
ADDRESS -L- a 6 h,,L,'
PHONE qyq - ,3L/y -g',;kg4 EMAIL
APPLICANT NAME -,t. /G -S
ADDRESS r U Q 6Z4
1L' ICI if/ - t.La�•
le && EMAIL a0_0_LL_ F�'e(,,A i IL Gg J 5
PHONE �� ' � tlp�3 - -
CONTRACTOR'S NAME 14•/L laSG� OWNER BUILDER? 0 YES O NO
BUSINESS NAME /L
ADDRESS nG, L G L CC//�
PHONE !�l -(.po� -'4zte4p EMAIL a 7 ;
CONTRACTOR'S STATE LIC NUMBER c'3 LICENSE CLASSIFICATION - (S
VALUATION$ ;;? b — SO FT !'/2-3 L SO FT
APPLICANT'S SIGNATURE DATE
OTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION �[ CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING E GREEN I SMIP
INVOICE PAID AMOUNT
AMOUNT ' O CASH O CHECK# O CREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Department 29714 Hawn Rd. Menifee, CA 92586 951-672-5777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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