PMT17-04369 City of Menifee Permit No.: PMT17-04369
29714 HAUN RD.
'/�CCELA> MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued:
1 211 112 0 1 7
PERMIT
Site Address: 27069 BOTTLEBRUSH LN, MENIFEE, CA Parcel Number: 335-362-038
92586 Construction Cost: $15,097.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE AC 4 TON AND FURNACE 80K BTU
Work:
Owner Contractor
JOHN ARNOLD W C HEATING&AIR CONDITIONING INC
27069 BOTTLEBRUSH LANE 41085 GOLDEN GATE CIR
MENIFEE,CA 92586 MURRIETA,CA 92562
Applicant Phone:9516000700
W C HEATING&AIR CONDITIONING INC License Number:779604
41085 GOLDEN GATE CIR
MURRIETA, CA 92562
Phone:9516000700
Fee Description QtV Amount W
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
'IN CITY OF MENIFEE
/LICENSED DECLARATION property who builds or Improves thereon,and who contracts for the projects
i 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 I am 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 210f U/q�en.- 1-7 (D 1 By my signature below I acknowledge that,except for my personal residence
Expires Signature -!I in which I 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
❑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. www.leeinfo.ca.gov/calaw.html.
Policy# Date -
❑I have and will maintain workers 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 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 I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# 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
❑I certify that In the performance of the work for which this permit is issued,
1 shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
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 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 s ecified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes ZNo
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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidell9es
CONSTRUCTION LENDING AGENCY oyes dNo
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 bougdary of a school?
(Section 3097 Civil Code) o Yes af 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 reason(s)indicated below by the California Hea h&Safety Code,Section 255DS and 25534 concerning
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 ha ardousTlalr�epq .
Business and Professions Code).Any city or county that requires a permit toes
Date
construct,alter,improve,demolish or repair any structure,prior to Itsto PRO ERTY 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 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 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
o 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.epa.gov/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. o No EPA Lead-Safe Certified Firm is required for this project because:
o 1,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 FlII out the RRP
Acknowledgement.
4L
DATE:12/11 o'kOI-7 PERMIT/PLAN CHECK NUMBER T WI-1-OLI'IA/(Q
TYPE: O COMMERCIAL ii RESIDENTIAL O MULTI-FAMILY O MOBILE HOME -- POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL IeMECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK REPLACE AC 4 TON AND FURNACE 80K BTU
PROJECTADDRESS 27069 BOTTL RUSH LANE Zip GI c0
ASSESSOR'S PARCEL NUMBER �� 3(pa -o3s5LOT TRACT
OWNER NAME JOHN ARNOLD
ADDRESS 27069 BOTTLE BRUSH LN. SUN CITY CA 92586
PHONE 951-301-9381 EMAIL
APPLICANT NAME MITCH BLUMAN
ADDRESS 31225 LA BAYA DR. #213 WESTLAKE, CA 91362
PHONE 818-735-7876 EMAIL
CONTRACTOR'S NAME WC HEATING & AIR CONDITIONING OWNER BUILDER? O YES ONO
BUSINESS NAME WE CARE HEATING &AIR CONDITIONING
ADDRESS 41085 GOLDEN GATE CIR MURRIETA, CA 92562
PHONE 951-600-0700 EMAIL
CONTRACTOR'S STATE LIC NUMBER 779604 LICENSE CLASSIFICATION C20
VALUATION$ 15,097 QFT LSQFT
APPLICANT'S SIGNATURE DATE 12/11
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION bj CITY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY: V
PERMIT FEE o3� , IO SMIP FF GREEN
PLAN CHECK FEE INVOICETOTAL
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE It NOTARIZED LETTER 0 YES 0 NO
City of Menifee
�
uIldinp Dept.
City of Menifee Building&Safety Deportment 29714 Haun Rd. Menifee, C 9258 951-672-6777
www.cityofinenifee.us DEC 1 1 20V
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