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PMT17-00954 City of Menifee Permit No.: PMT17-00954 29714 HAUN RD. Type: Residential Mechanical <—ACCF1./-> MENIFEE,CA 92586 °f"-"ASA'A- MENIFEE Date Issued: 04/03/2017 PERMIT Site Address: 28663 SHADY BROOK DR, MENIFEE,CA Parcel Number: 340-250-039 92584 Construction Cost: $11,350.00 Existing Use: Proposed Use: Description of REPLACEMENT OF EXISTING HEATING AND AIR CONDITIONING SYSTEM W/NEW 4 TON SPLIT Work: HORIZONTAL HVAC SYSTEM, INCLUDING RELOCATION OF CONDENSING UNIT Owner Contractor KEN PETERS CASTILLO HEATING&AIR CONDITIONING INC 28663 SHADY BROOK DR 32105 HEATHER LANE MENIFEE, CA 92584 MENIFEE,CA 92584 Applicant phone: 9513014452 ART CASTILLO License Number:548323 CASTILLO HEATING&AIR CONDITIONING INC 32105 HEATHER LANE MENIFEE, CA 92584 Fee Description City Amount I$ 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_eldg_Permit_Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION hereby affirm under penally or perjury(hat I am licensed under provisions of ❑ I, as Owner of the property an exclusively contracting with licensed Chapter (commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044,Business and Professions Professions Code and my license is in full force and effect. Cade:The Contractor's License Law does not apply to an ownerof a property Ucense Gass 111- 20 Ucense No y54 who builds or improves thereon, and who contracts for the pmlecls with a Expiresr`7�:1 y0l(�Signature d GAL: y licensed contlaclor(s)pursuant to the Contractors State License Law). l WORKERS'COMPENSATION DbYaRATION ❑ lam exempt from Itcensure under the Contractors'Slate License Law for Ore ❑ 1 hereby affirm under penally of perjury one of the following declarations: following reason: I have and will maintain a certificate of consent or self-insure for workers' By my signature below I acknowledge That except for my personal residence in compensation.issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of permit i 3ssu of the Labor Code,for the performance of work for which This improvements covered by this permi4 I cannot legally sea a structure that 1 have Policy is issued. Policy# built as an owner-building if it has not been constructed in its entirety by licensed mNraclars.I understand that a copy of The applicable law,Section 7044 of The Q� 1 have and will maintain workers'compensation Insurance,as required by Business and Professions Code,is available upon mquestwhen this application Is section 3700 of the Labor Code, for the performance of The work for which this submitted or at the following Web site:hno•I/wvv..leginfo.m.00vlcelawhtml. permit Is issued.My Workers'compensation insurance carrier and policy number are: Carrier SC.1. F Property Owner or Authorized Agent Date Explres 10/01/2016 Pollcy# 00 24 656 Name oFAgant.j;1if12J )D�1yL1pt� Phone 2 q 5 I-Z(a5:'444� 0 By my Signature below,I certify to each of the fallmving:I am the property owner or authorized to act on the property owners behalf. I have read this MIS section need not be completed If the permit is for application and the information I have provided is coned. I agree to comply one-hundred dollars(S100)or less) with all applicable city and county ordinances and state laws relating to building construction.I authorize represpt alf�fr es ofghl"''ty,or county to enter the above- ❑1 certify,That in the performance of the work for which this permit is Issued,I identified camped,Sogth in paction purp6sas°.i shall not employ an persons in an manner so as to become subject to the r F} F workers cotnpensaiipn laws Of California.and agree that if 1 should became subject to the workers'compensation provisions of Section 3700 of the Labor prop' A•nor orAOthorized Agent Date Code,I shall forthwith comply with those provisions. � „ Data; Applicant;—•,,.9 �, _J ^,�.?{' GIyB m mess License d (Y 710 WARNING, FAILURE TO ECURE WORKERS' HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE IS OjNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING (S100,000),IN ADDITION TO THE COST OF COMPENSATION, DYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE,INTEREST,AND ATTORNEYS FEES NO EQUAL TO OR GREATER THAN THE AMOUNTS CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS I hereby alarm that under the penalty of perjury there is a conshuclion lending INFORMATION GUIDE? agency for the performance of the work which this permit is issued(Section WILL THE INTENDED USE OF THE BUILDING BY THE 3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE Lender's Name D� Y/ES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION Lender's Address ffN FROM THE SOUTH COAST AIR QUALITY MANAGEMENT 0 DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR OWNER BUILDER DECLARATIONS GUIDE LINES I hereby alarm under penalty or perjury that I am exempt from the Contractor's PRI14T NAME: License Law for Ne Feason(s)indicated below by the checkmark(s)I have placed DYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY next to The applicable items)(Section 7031.5.Business and Professions Code: � / BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A -Any city or county that requires a permit le construct,alter,Improve,demolish, 1a10 SCHOOL? or repair any structure,prior To Its 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 Slate License Law(Chapter 9(commencing with 1� 1 HAVE READ THE HAZARDOUS MATERIAL Section 7000)of Division 3 of the Business and Professions Code)or that he or diEs INFORMATION GUIDE AND THE SCAOMD PERMITTING she is exempt tram Ilcensure and the basis for The alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY a dull penalty of not more than(5500).) CODE SECTION 2550�5533 AN C NCERNING D I, as mvner of The property. HAZAfI0005 MATER OR1'I p party. or my employees with wages as (heir sole j n compensation,will do( )all of or( )porting of the work,and the structure is PROPERTY WNE AIfT Y r/ not Intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X who, Through employees'or personal effort, builds or Improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion.The Owner- Builder will have the burden of proving that It was not built orimpmved for the purpose of sale). BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION Menifee DATE Ken Peters PERMIT/PLAN CHECK NUMBER I 1 —O TYPE: O COMMERCIAL 6 RESIDENTIAL O MULTI-FAMILY O MOBILE HOME 0 POOLISPA O SIGN SUBTYPE: O ADDITION &ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK Replacement of existing heating and air conditioning system with new 4 ton split horizontal central heating and air conditioning system,including relocation of condensing unit. PROJECTADDRESS 28663 ShadyBrook Drive Menif CA j y258,4 ASSESSOR'S PARCEL NUMBER 3� -,ZO -O 1 LOT :5A TRACT OWNER NAME Ken Peters ADDRESS 28663 Shady Brook Drive Menifee CA 92584 PHONE 310-427-1506 EMAIL SKPLA26 YAHOO.COM APPLICANT NAME Castillo Heating and Air Conditioning, Inc. ADDRESS 32105 Heather Lane Menifee, CA 92584 PHONE 951-301-4452 EMAIL info@castillohvac.net CONTRACTOR'S NAME Art Castillo OWNER BUILDER? O YES ONO BUSINESS NAME Castillo Heating and Air Conditioning, Inc. ADDRESS 32105 Heather Lane Menifee, CA 92584 PHONE 951-301-4452 EMAIL info@castillohvac.net CONTRACTOR'S STATE LIC NUMBER 548323 LICENSE CLASSIFICATION C20 VALUATION$ 11,350 SO FT 2,144 L SO FT APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION p CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I GREEN r SMIP INVOICE •IQ AMOUNT PAID AMOUNT 0CASH 0 CHECK N OCREDITCARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. 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