PMT17-02503 City of Menifee Permit No.: PMT17-02603
29714 HAUN RD. Type: Residential Mechanical
<nCCELn? MENIFEE, CA 92586
MENIFEE Date Issued: 0 711 912 01 7
PERMIT
Site Address: 27755 BARONI RD, MENIFEE,CA 92585 Parcel Number: 329-050-039
Construction Cost: $11,000.00
Existing Use: Proposed Use:
Description of HVAC REPLACEMENT, PACKAGE UNIT,4 TON A/C, 90,000 BTU FURNACE(ROOF)
Work:
Owner Contractor
LARRY HOLLOWAY W C HEATING&AIR CONDITIONING INC
27755 BARONI ROAD 41085 GOLDEN GATE CIR
MENIFEE, CA 92585 MURRI ETA, CA 92562
Applicant Phone:9516000700
JILL WESTON License Number:770604
W C HEATING&AIR CONDITIONING INC
41085 GOLDEN GATE CIR
MURRIETA,CA 92562
Fee Description Qtv Amount f$1
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 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
1 hereby affirm under penalty of perjury that 1 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 o I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license Is in full force and effect. the following reason:
License Class C920 License No. D—Iq LQ4 By my signature below I acknowledge that,except for my personal residence
Expires (2(301)5s Signature 1 0_A_. �.(�.O;A9 in which 1 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 DECIARATI
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.m.eov/alaw.html.
this permit is issued. c�
Policy# Wcu C..Qz��...�L6% Date
PROPERTY OWNER OR AUTHORIZED AGENT
o l have and will maintain worker's compensation insurance,as required by
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 worker's compensation Insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
numberare: application and the information I have provided is correct.I agree to comply
�•1.1{JYeSS with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
@
Policy# P�(ajC_1.1L7tL0 Expires�/l / \ 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
certify that in the performance of the work for which this permit is issued, nn
I shall not employ 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 compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant��L 11)_l�-'�,.� Date mixture containing a hazardous material equal to or cation Guidehat?
e
amounts specified on the Hazardous Materials Information Guide?
WARNING:F LURE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0 Yes 1.1"'o
UNLAWFUL,AND SHALLSUBIECT AN EMPLOYERTO CRIMINAL PENALTIES Will the Intended use of the building bythe applicant or future building
AND CIVIL FINES UP TO ONE HUNDREDTHOUSAND 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 forguid�eli�n.1es
CONSTRUCTION LENDING AGENCY rz
Yes 5 o
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) o Yes ❑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 California Health&Safety Code,Section 25505 and 25534 concaming
Contractor's License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes o r. �,(�
Business and Professions Code).Any city or county that requires a permit to W, ec>\C1v Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY 1 INER 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 IRRP)
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 Ilcensure 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 workthemselves orthrough 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 Contractor's State license Law does not apply to an owner of a ❑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. a No EPA Lead-Safe Certified Firm Is required for this project bemuse:
❑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.
16". Menifee
`^ = PERMIT/PLAN CHECK NUMBER
1-*'e: 1C�`.^.LcaIIAL ❑RmCENTLAL MULTI-FAMILY ❑MOBILEHOME POOL/SPA ❑SIGN
S17aT1^r E: [I-ADDITION MECHANICAL
❑\aY ❑PLUMBING [I RE-ROOF-NUMBER OF SQUARES
h1'AC R rLACEMENT.PACKAGE UNIT,4 TON A/C.90K BTU FURNACE(ROOF)
it of Menifee
Building & Safety Dept.
27755 FARO\I RD
ap- 6W•6�1 LOT TRACT JUL 18 2017
?ecW_'�i"iY Olti^:ER•5 NAME LARRY HOLLOWAY
KulurdivWU
.Z 1=SARCR\9 RD
__C!i= (951)25931S5 EMAIL
APPLICANT NAME T%=GREEN
r� 3645-RUFFIN RD,#330 SAN DIEC:C__.92123 -
(319)63D-ISM EMAIL
CONTRACTOR'S NAME RUSSELL COCHRAN OWNERBUILDER7 ❑YES❑NO
3U5It:ESS NAME Y!E CARE
ADDRESS 41085 GOLDEN GATE CIRCLE MURRIETA CA 91362
PHONE (951)600-7000 EMAIL
Coln RACTOR'S STATE UC NUMBER
779604 LICENSE CLASSIFICATION C20
VALUATION$ S11,000.00 SOFT 1762 LSQFT
APPUCAtfr'S SIGNATURE DATE
CITY OF MENIFEE BUSINESS LICENSE NUMBER
CEpARfl/.rl(T DISTRIBUTION
g`Jltag(G PLANNING ENGINEERING FIRE GREEN SMIP
IIP/OICE PAIDAMOUNT OCASH OCHECKK OCREDITCARD VISAJMC
W.Outir
PLAN CHECY.FEES PAID AMOUNT O CASH O CHECK R O CREDn'CARD VLsa/M[
O'IlItER BUILDER VERIFIED NOTARIZED LETTER O YES O NO
OYES O NO DLNUMBER
City of Menifee Building E Safety Deportment 29714 Haun Rd.Menifee,CA 925S6951-672-6777
www.cityofinenl(ee.us Inspection Request Line 951-246.6213
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