PMT17-00932 City of Menifee Permit No.: PMT17-00932
29714 HAUN RD.
<�CCEL/-> MENIFEE,CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 03/29/2017
PERMIT
Site Address: 26575 ALTA AVE, MENIFEE, CA 92585 Parcel Number: 331-462-006
Construction Cost $12,000.00
Existing Use: Proposed Use:
Description of REPLACE 5 TON A/C, 100,000 BTU FURNACE HVAC SYSTEM
Work:
Owner Contractor
PEDRO DEBARAN TOTAL COMFORT INC
26575 ALTA AVE 390 E HARRISON STREET
MENIFEE,CA 92585 CORONA, CA 92879
Applicant Phone:9517352574
MITCH BLUMAN License Number:935238
TOTAL COMFORT INC
390 E HARRISON STREET
CORONA, CA 92879
Fee Description O_yt Amount ISI
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_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects I
`I
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 section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. yq� the following reason:
License Class C70 i G 3 License No. —I �S 2,3 "
By my signature below I acknowledge that,except for my personal residence
Expires 3( 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 DECLARATION have built as an owner-builder if 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 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
www.leeinfo.ca.aov/calaw.html.
his permit Is Issued.
Policy# Date
Al 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 area:s'^ a application and the information I have provided is correct.I agree to comply
Carrier '4"°r�''" G� {' t✓ with all applicable city and county ordinances and state laws relating to
/I L ) building construction.I authorize representatives of this city or county to
Policy# WSD.6 2 V%6 q Expires �l 1�/(� 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, ��O
1 shall not emolov 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 I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's c satkm provisions of Section 3700 of the Labor
Code,I shall fo hw'th y with those provisions. Will the applicant or future building occupant handle hazardous material or a
3 2n 1-7 mixture containing a hazardous material equal to or greater that the
Applicant Date amounts s cified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes dco
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 guidelijnes
CONSTRUCTION LENDING AGENCY o Yes 0
1 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 bouppdary of a school?
(Section 3097 Civil Code) ❑Yes id No
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
C California Health&Safety Cade,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the
hazardaus�material reps
chetkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Oyes 6f �s
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 pROPE OWNER 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 RENOVATION,REPAIR AND PAINTING IRRPj
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
o 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.eoa.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 Contractor's State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovatorwill 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. YNo EPA Lead-Safe Certified Firm is required forthis project because:
o 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.
BUILDING & SAFETYPERMIT/PLAN APPLICATION
MS�.or
Menifee
DATE 15 Zq I Z PERMIT/PLAN CHECK NUMBER I r
TYPE: ❑COMMERCIAL RESIDENTIAL MULTI-FAMILY MOBILE HOME POOL/SPA SIGN
SUBTYPE: [-]ADDITION ❑ALTERATION []DEMOLITION [—]ELECTRICAL EIMECHANICAL
[_]NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 12e oka-crz ZrLA wm`w, (0 k $CU
PROJECTADDRESS `Z(p 515 �-O .AalCL4-
ASSESSOR'S PARCEL NUMBER p331 l j�pp(O LOT 51 TRACT ag1l3- 1
PROPERTY OWNER'S NAME L nnE 0 f o
ADDRESS 2C9 5 7 5 f�� A.a l{{77 z ow)ok,%^ 11cfc q ?,5
PHONE 053 EMAIL
APPLICANT NAME MA& C� +^- /a
ADDRESS 3,225 L-` Qr, 3 We <i+{ake-
C�4
PHONE 7175-w-76 EMAIL
CONTRACTOR'S NAMEI TO koL( om(p + OWNER BUILDER? ❑YES❑NO
BUSINESS NAME ! Ok0,(
ADDRESS 3q0 E- 90`cc 0v-\ '5V Cb Val-no C'Q g2VT
PHONE $N,L( -$2LA '�7i-\ EMAIL 0L'ML1'0+oA"A L owl�ai ( nC.h
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION C'J 0 C 0
VALUATION$ l71600 QFT LSQFT
APPLICANT'S SIGNATURE DATE pJ Z f 7
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN Ito SMIP
INVOICE 'J� Q PAIDAMOUNT - �,,
AMOUNT �/ .I " CASH CHECK# -CREDR CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CASH CHECK# CREDITCARD VISA/MC
OWNER BUILDER VERIFIED C. YES O NO DL NUMBER NOTARIZED LETTER C. YES C NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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