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PMT18-00136 City of Menifee Permit No.: PMT18-00136 29714 HAUN RD. Type: Residential Mechanical '(�kCCELA> MENIFEE, CA 92586 MENIFEE Date Issued: 01/1012018 PERMIT Site Address: 26515 ALTA AVE, MENIFEE, CA 92585 Parcel Number: 331-462-001 Construction Cost: $5,000.00 Existing Use: Proposed Use: Description of REMOVE AND REPLACE HVAC-3 TON 16 SEER FURNACE-70K BTUS Work: SAME SIZE AND LOCATION Owner Contractor ALEXANDER STEWART KMA HVAC INC 26515 ALTA AVE 25920 IRIS AVE 13A-400 MENIFEE, CA 92585 MORENO VALLEY,CA 92551 Applicant Phone:8777178732 KMA HVAC INC License Number: 1023799 25920IRIS AVE 13A-400 MORENO VALLEY, CA 92551 Phone:8777178732 Fee Description Div Amount 151 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 staled,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 Templale.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 contractOT(a)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and a 1 am exempt from Iicensure under the Contractors State License Law for Professions Code and my license is In full force and effect. the following reason: License Class VLO License No. �u 2s1 By my signature below I acknowledge that,except for my personal residence Expires Z Signature A in which l must have resided for at least one year prior to completion of WORKER'S COMPENSATION DECLARATION improvements covered by this permit.1 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 www.leginfin.m.90Y/calaw.1affll.permit is issued. Policy# Date O 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 workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this number are: I`1 application and the information I have provided is correct.I agree to comply Carrier N 0< (A with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy# 'kM Wtd �12_ 1�j�Expires 11601-1 enter the above identified property for inspection purposes. (This section need not to be completed is the permit A for one-hundred Date dollars($100)or less PROPERLY OWNER OR AUTHORIZED AGENT— ❑1 certify that In the performance of the work for which this permit is issued, Ishallnotemolov 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 f4rt((zwi h comp) with those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant_ Date f(7 I mixture containing a hazardous material equal to or greater that the sl amounts speufed on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ayes a No 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($1D0,000),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 cons(SCtionor odi permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Airines CONSTRUCTION LENDING AGENCY o Yes o 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) ❑Yes o No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAOMD I hereby affirm under penalty of perjury that I am exempt from the Permitting checklist.I understand my requirements under the State of Contactors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.ayes ❑No Business and Professions Code).Any city or county that requires a permit to Date construct,alter,improve,demolish or repair any structure,prior to its PROPERTY 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(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 70315 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 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 wwrmeoa.eov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-80D-424-LEAD(5323). Code;The Contactors 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 LeadSafe Certified Firm Is required for this project because: o I,as owner of the property am exclusively contacting with licensed contactors to construct the project(Section 7044,Business and Professions Code:The Contactors 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 IL Menifee DATE: PERMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL CILMECHANICAL O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK (,WA-0 0i1 - Tg foN lip 5 ' F- PROJECT ADDRESS tiU' 1 q PVT 4 PNt ZIP ASSESSOR'S PARCEL NUMBER 3?j 1• (.(03, '00 I LOT TRACT OWNER NAME Rv 01yelL 5ti rw ADDRESS 1/v 5 pri/14 Av' PHONE "Is EMAIL APPLICANTNAME NA14wS Lotle ADDRESS 1/ 017,0 5 fW' oo N`� -,00UA- ��AA °1'L PHONE '16t 4jbUI 0&4,1 EMAIL CONTRACTOR'S NAME t'-M A 1�V" OWNER BUILDER? OYES ONO BUSINESS NAME ktA lk ADDRESS 1,5h 4L6 �(GIS A%1F, Af 13 A Da PHONE W51 411(o 0511 EMAIL hw4 A) N'0'�t►1AtI,, CONTRACTOR'S STATE LIIC NUMBER 10151E4 a1 LICENSE CLASSIFICATION VALUATION$ ` (J SQ FT L SQ FT APPLICANT'S SIGNATURE / DATE I (^ CITY STAFF USE ONLY- DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENG ERING FIRE ACCEPTED BY: PERMIT FEE ,. , SMIP GREEN PLAN CHECK FEE INVOICE TOTAL OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO City of Menifee Building Dept. City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us JAN I U 20i01 Received m w m a N i° u, w N N D o D m n A Z �; Vni d n N fl D D a a 7 ,� o.di. �+ o o -ri -ri rf m Z m 3 � m n < ''1 .^. Q N � o m 3 m r 3 p a m i D v M A X 3 N O N N n N 3 3 eNi in N d N O O O O Q i N S C m n S m m J < O O pl J 3 00 7 D w m m J D .Os d J � N ° < m < N � o ° m O O w O fD x D ae fU J Jn J D m :*' d O. 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