PMT17-04048 City of Menifee Permit No.: PMT17-04048
29714 HAUN RD.
�A_CCELAI? MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued:
11/17/2017
PERMIT
Site Address: 28482 SCENIC BAY CV, MENIFEE, CA Parcel Number: 333-532-003
92585 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of HVAC REPLACEMENT,3 TON A/C(BACKYARD),90,000 BTU FURNACE(ATTIC)
Work:
Owner Contractor
WAYNE&NANCIE RODGERS W C HEATING&AIR CONDITIONING INC
28482 SCENIC BAY COVE 41085 GOLDEN GATE CIR
MENIFEE, CA 92585 MURRIETA,CA 92562
Applicant Phone: 9516000700
JILL WESTON License Number:779604
W C HEATING&AIR CONDITIONING INC
41085 GOLDEN GATE CIR
MURRIETA, CA 92562
Fee Description Oft Amount I$)
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_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 contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o 1 am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class C 920 License No. By my signature below I acknowledge that,except for my personal residence
Expires 600 I a Signature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATICW 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
❑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
this permit is issued. �r� www.leeinfo.a.eov/alaw.html.
Policy# IL.i C-U C, t� � Date
❑I have and will maintain workers compensa tlon 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.1 agree to comply
Carrier_ C 1 with all applicable city and county ordinances and state laws relating to
building construction.)authorize representatives of this city or county to
Polity# (j.J(.1.1C.�6(�7lY0 Expires 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
o I certify that In the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# rngx e �
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,1 shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:F URE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes o)dlo
UNLAWFUL,AND SHALL SUBJECT AN 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 cost(SC construction
or See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo Coast
Airines
Qua
CONSTRUCTION LENDING AGENCY a Yes WNo
1 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 o No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I 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 resson(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable Rem(s)(Section 70315 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to Dyes aW W Date
i sa alter,improve,demolish or repair any structure,signets its PROPERTY NER OR AUTHORIZED AGENT
ssuuancence,,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contactors State EPA RENOVATION,REPAIR AND PAINTING LRRP)
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 apes-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or compensation
n for most
beork that
firms and comply with
than
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
❑1,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 O 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 bemuse:
a 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.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
Menifee
DATE 11/13/2017 PERMIT/PLAN CHECK NUMBER f 1" 1\ r
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: []ADDITION ❑ALTERATION []DEMOLITION [-]ELECTRICAL ❑✓ MECHANICAL
❑NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK HVAC REPLACEMENT.3 TON A/C(BACKYARD),90K BTU FURNACE(AnVll Of Menifee
Mpg Dent,
PROJECTADDRESS 28482 SCENIC BAY COVE
ASSESSOR'S PARCEL NUMBER �n,3- �Gjj LOT TRACE Raceivai
PROPERTY OWNER'S NAME WAYNE&NANCIE RODGERS
ADDRESS 28482 SCENIC BAY COVE
PHONE (951)246-4181 EMAIL
APPLICANT NAME JILL WESTON
ADDRESS 3645 RUFFIN RD 330-335 SAN DIEGO,CA 92123
PHONE (619)384-6622 EMAIL
CONTRACTOR'S NAME RUSSELLCOCHRAN OWNERBUILDER? ❑YESONO
BUSINESS NAME WC PLUMBING, HEATING&AIR
ADDRESS 41085 GOLDEN GATE CIR MURRIETA, CA 92562
PHONE (951)600-0700 EMAIL
CONTRACTOR'S STATE LIC NUMBER 779604 LICENSE CLASSIFICATION C20
VALUATION$ $10,000.00 SO FT 3000 L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP k
INVOICE �/� O PAIDAMOUNT
AMOUNT • lV CASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES 0 NO
City of Menifee Building& Safety Deportment 29714 Haan Rd. Menifee, CA 92586951-672-6777
.vw6v.atyofinenifee.us ln5pection Request Line 951-245-6213
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