PMT17-01476 City of Menifee Permit No.: PMT17-01476
29714 HAUN RD.
<JICCELA> MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 05/1212017
PERMIT
Site Address: 31430 WILLOWOOD WAY, MENIFEE, CA Parcel Number: 372-031-013
92584 Construction Cost: $8,000.00
Existing Use: Proposed Use:
Description of REPLACE 66,000 BTU FURNACE&3 TON (16SEER)A/C UNIT
Work:
Owner Contractor
WILLIAM ROSSI COOL AIR SOLUTIONS INC
31430 WILLOWOOD WAY 41162 SANDALWOOD CIR STE 101
MENIFEE,CA 92584 MURRIETA,CA 92562
Applicant Phone:9516762665
JANE RECKTENWALD License Number:874502
COOL AIR SOLUTIONS INC
41162 SANDALWOOD CIR STE 101
MURRI ETA, CA 92562
Fee Description OQt Amount IEl
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 9 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 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 a^nd{��my license is in full force and effect. �SS the following reason:
License Class �OWJ License No. g�—I rJOa By my signature below I acknowledge that,except for my personal residence
Expires 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
D 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
this permit is issued. www.leginfo.ca.govlcalaw.html.
Policy# Date
o l 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 o 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.I agree to comply
Carrier_�yQ,`�$S- \VGtS�01/1.GL.1 with all applicable city and county ordinances and state laws relating to
rr building construction.I authorize representatives of this city or county to
Policy# 'lhCAM1:K— j Expires enter the above ide 'red operty for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date 7 i�
dollars($300)or less PROPERTY OWNER O THORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued, -,�
I shall not emolov any persons In any manner so as to become subject to the CITY BUSINESS LICENSE# (]6541�—�
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 comply wi se provisions. �L Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to orgreater thatthe
amounts�specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECUR RKER'S COMPENSATION COVERAGE IS 0 Yes 0
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES WIII 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 COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 37060F THE
HE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes IFNo
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) ❑Yes �ro
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that 1 am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health al Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.
.pdPfi
Business and Professions Code).Any city or county that requires a permit to oYes 7" Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY 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 Contractors State EPA RENOVATION,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-certfied 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($S00). managers who do the paint-disturbing work themselves or through their
D 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 Contractors State License Law does not applyto an owner of a 0 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 itwas
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 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.
BUILrING & SAFETY PERMIT/PLAN CHECK APPLICATION 7
DATE 5-10-17 PERMIT/PLAN CHECK NUMBER
TYPE: COMMERCIAL V'RESIDENTIAL MULTI-FAMILY MOBILE HOME POOL/SPA SIGN
SUBTYPE: C ADDITION o ALTERATION ': DEMOLITION ELECTRICAL VMECHANICAL
NEW PLUMBING •:J RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK -Replace 66,000 btu furnace & 3 ton 16 seer) A/C unit
PROJECTADDRESS 31430 Willowood Way Menifee CA 92584
ASSESSOR'S PARCEL NUMBER 372-031-013 LOTI?Xe TRACT '2'
OWNER NAME William Rossi
ADDRESS 31430 Willowood Way Menifee, CA 92584 _
PHONE 951-553-9661 EMAIL
APPUrANTNAME Jane Recktenwald
ADDRESS
PHONE 714-336-6159 EMAIL
CONTRACTOR'S NAMEInc OWNER BUILDER? YES ENO
BUSINESS NAME
ADDRESS 41162 Sandalwood Cir Ste 101 Murrieta, CA 92562
PHONE 951-676-2665 EMAIL
CONTRACTOR'S STATE LIC NUMBER 874502 LICENSE CLASSIFICATION C20
VALUATION$ 8,0000.00 SO FT L SO FT
T
APPLICANT'S SIGNATURE DATE 5-10-17
DEPARTMENT DISTRIBUTIDN Cl-, OF.MEWEE BUS!NSS LICENSE NUMBER
BUILDING PLANNING ENGINEERING PRE I GREEN I job SMIP
INVOICE I r PAID AMOUNT
AMOUNT 'CASH .CHECK P CREDIT CARD VISA/MC-
PLAN CHECK FEES PAID AMOUNT a CASH CHECK n CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED YES NO DL NUMBER NOTARIZED LETTER YES NO
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