PMT17-01982 City of Menifee Permit No.: PMT17-01982
_ 29714 HAUN RD.
�/-�CCEL/? MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 06/21/2017
PERMIT
Site Address: 29518 WINDING BROOK DR, MENIFEE, Parcel Number: 340-250-027
CA 92584 Construction Cost: $11,799.00
Existing Use: Proposed Use:
Description of REPLACE 100,000 BTU FURNACE,5 TON(16SEER)A/C UNIT&COIL
Work:
Owner Contractor
RUSS BLOYER PEACH HOME SERVICES INC
29518 WINDING BROOK DR 532 MALLOY COURT
MENIFEE, CA 92584 CORONA,CA 92880
Applicant Phone: 7144628174
JANE RECKTENWALD License Number. 1018348
PEACH HOME SERVICES INC
532 MALLOY COURT
CORONA, CA 92880
Fee Description Q1t r Amount f51
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 carded on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a peril 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_BIdg 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 D I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full form and effect. the following reason:
License Class r an.Cz,-k, .Ucense No. W 12?3A S
- oo�� By my signature below I acknowledge that,except for my personal residence
Expires Q-�-t? Signature in which l must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
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 workers 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.IeRlnfo.ca.gov/caIaw.htmI.permit is issued.
Policy# Date
D I have and will maintain workers compensa(ion 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 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 N-CLO a-Ls.+ M\GW2C-t' with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#% L'd2LQ Itr$t{ Expires ETi— n 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 O UTH AGENT
D 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# 0-1 ?!:IpS
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensatio ovisions of Section 3700 of the Labor
Code,I shall forthwith comply ose provisio S. �7 Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to orgreater that the
Applicant Date 6,�-1-1 1
amounts fs ecified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SE�WREWO KER'S COMPENSATION COVERAGE IS 0Yes N0
UNLAWFUL,AND SHALL SUBJ #EMPLOYER TO CRIMINAL PENALTIES Will thelllll 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 forguidelines
CONSTRUCTION LENDING AGENCY ❑yes �No
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) Dyes �tQo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
1 hereby affirm under penalty of perjury that I 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
hazardous material repo g.
checkmark(s)I have placed nett to the applicable item(s)(section 7031.5 0Yes 'eTNo
Businessand Professions Code).Anycity or county that requires a permitto Date ��
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR A H IZED 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(RRPI
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 Iicensure 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
❑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 apply to an owner of a D 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:
D 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.
SAFETY PERMIT/PLAN CHECK APPLICATION
r_
C'
Menifee
DATE 6-20-17 PERMIT/PLAN CHECK NUMBER T1 rl - ® 1
TYPE: U COMMERCIAL VRESIDENTIAL O MULTI-FAMILY O MOBILE HOME D POOL/SPA SIGN
SUBTYPE: O ADDITION 0 ALTERATION 0 DEMOLITION O ELECTRICAL WMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK c e 100,000 btun furnace. 5 ton 16 seer) A/C unit & coil
PROJECTADDRESS 29518 Winding Brook Dr Menifee, CA 92584
ASSESSOR'S PARCEL NUMBER 340-250-027 LOT TRACT
OWNER NAME Russ Bio er
ADDRESS 29518 Winding Brook Dr Menifee, CA 92584
PHONE 951-430-4330 EMAIL
APPLICANTNAME Jane Recktenwald
ADDRESS
PHONE 714-336-6159 EMAIL
CONTRACTOR'S NAME 's Heating & Air OWNER BUILDER? OYES VNO
BUSINESS NAME -eaf-V-N FIVYYV
ADDRESS 532 Malloy Crt Corona, CA 92880
PHONE _ 951-737-4141 EMAIL
CONTRACTOR'S STATE LIC NUMBER 10 B348 LICENSE CLASSIFICATION C20 C36
VALUATION$ 11 799.00 SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE 6-20-17
DEPARTMENT DISTRIBUTION I M CITY OF MENIVEB Sy INi$$,kICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN W SMIP tj`-J�/V�-�./-��/�)L./•
INVOICE PAID AMOUNT
AMOUNT •� O CASH O CHECK N O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMRER NOTARIZEDLETTER O YES. 0 NO
City of Menifee Buildinq&Safety Deportment 29714 Houn Rd. Menifee, CA 925S6 951-672-6777
www.diyafrnenifee.us Inspection Request tine 951-246-5213
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