PMT17-01852 City of Menifee Permit No.: PMT17-01852
29714 HAUN RD. Type: Residential Mechanical
4ACCELA? MENIFEE,CA 92586
MENIFEE Date Issued:
O6/1212017
PERMIT
Site Address: 31128 GREEN FOREST DR, MENIFEE, Parcel Number: 372-014-015
CA 92584 Construction Cost: $3.000.00
Existing Use: Proposed Use:
Description of REPLACE A/C COIL&CONDENSER IN SAME LOCATION,5 TON
Work:
Owner Contractor
ARLENE ORTIZ TRUTEAM OF CALIFORNIA INC
31128 GREEN FOREST DR 260 JIMMY ANN DRIVE
MENIFEE,CA 92584 DAYTONA BEACH, FL 32114
Applicant Phone:3863042222
ED PONCE License Number:221517
TRUTEAM OF CALIFORNIA INC
260 JIMMY ANN DRIVE
DAYTONA BEACH, CA 32114
Fee Description ON Amountl$
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 peril 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 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_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 contractors)pursuant to the Contractors State License Law).
Chapter9(com mencmg with section 7000)of Division 3 of the Business and aIam exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. —7 the following reason:
License Class L•-2 ri License No. ( /7� By my signature below l acknowledge that,except for my personal residence
Expires %ig2f_Z_Signature in which l must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that 1
WORKER'S COMPENSATION DECLARATION have built as an owner-builder If It has not been constructed in its entirety by
a I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that 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
cofirpensation,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 wwwleeinFo.ca.eov/calaw.lstmi.
this permit Is issued.
Policy If Dale
'7W 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 D By my signature below l 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 1 have provided IS correct.I agree to comply
Carrier R6 /qqY1f f'snrC n.� with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy g Q)L if c 47fC n i kn Expires /6a,1,2. 17 enter the
above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred �`_/ Date /0 h71Ze/F
dollars($1001 or less
M2 RTYOWNER ORAUTHORIZED AGENT
a l certify that in the performance of the work for which this permit is Issued, h�Lw'+� a
Ishallnntemolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE g IJ,�J•�/ (o
worker's compensation laws of California,and agree that if l should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 370D of the Labor
Code,I shall fart�h/w comply witthh't�bo�seprovisions. Will the applicant or future building occupant handle hazardous material or a
Appliant�//emu—/' �— Date /01711 mixture containing a hazardous material equal to or greater thatthe
amounts specified on the Hazardous Materials information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS oyes "o
UNLAWFUL,AND SHALLSUB1EC17AN 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
INSECLLON 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY ayes 0710
l 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) a Yes 9*0
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penally of perjury thatlam exemptfromthe permitting checklist.I understand my requirements under the State of
California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed nextto the applicable item(s)(Section 7031.5 /
Yes
Business and Professions Code).Any city or county that requires a permit to o e7e_ `r.1=6— Date /0174
construct,after,improve,demolish or repairany structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permitto file a signed statement
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIRAND PAINTING 1RRPI
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 properly
than($500). managers who do the paint-disturbing work themselves or through their
oil,as owner ofthe property,or my employee with wages as their sole employees.For more information about EPKs 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 aAn 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 a re 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. a No EPA Lead Safe Certified Firm is required for this project because:
a 1,as owner of the property am exclusively contacting with licensed
contactors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State license Law does not apply to an owner of a ifyour project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement
1 i SAFETY PERMIT/PLAN APPLICATION
Menifee
DATE 06/12/2017 PERMIT/PLAN CHECK NUMBER DI
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA [—]SIGN
SUBTYPE: ❑ADDITION []ALTERATION ❑DEMOLITION ❑ELECTRICAL ®MECHANICAL
❑NEW ❑PLUMBING ❑RE-ROOF-N UMBER OF SQUARES
DESCRIPTION OF WORK Replace A/C coil and condenser in same location.5 ton
PROJECT ADDRESS 31128 Green Forest Or ^�
ASSESSOR'S PARCEL NUMBER 'e> )L OILY —OAS LOT TRACT
PROPERTY OWNER'S NAME Arlene Ortiz
ADDRESS 31128 Green Forest Dr,Menifee CA 92584
PHONE (951)458-3367 EMAIL
APPLICANT NAME Edward Ponce
ADDRESS 475 Rivera St, Unit:D, Riverside,CA 92501
PHONE (951)722-6905 EMAIL
CONTRACTOR'S NAME Truteam of CA Inc OWNER BUILDER? ❑YES ZNO
BUSINESS NAME
ADDRESS 475 Rivera St, Unit:D, Riverside,CA 92501
PHONE (951)683-4429 EMAIL
CONTRACTOR'S STATE LIC NUMBER 221517 LICENSE CLASSIFICATION C20
VALUATION$ $3.000.00 SQ FT 2100 L SQ FT
APPLICANT'S SIGNATURE DATE 06/12/2017
crrysTAFF USE ONLY
ra
DEPARTMENT DISTRIBUTION I� CITY OF MENIFEE U I S UMBER
BUILDING PLANNING GINEERING FIRE GREEN l SMIP v
INVOICE PAIDAMOUNT
AMOUNT •I 0 CASH :=CHECK?{ C CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH C CHECK# C CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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