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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. 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