PMT18-02092 City of Menifee Permit No.: PMT18-02092
29714 HAUN RD. Type: Residential Mechanical
MENIFEE, CA 92586
MENIFEE Date Issued: 0 510112 01 8
PERMIT
Site Address: 28743 CARMEL RD,MENIFEE,CA 92586 Parcel Number: 337-222-014
Construction Cost: $3,000.00
Existing Use: Proposed Use:
Description of REPLACE FAU ONLY IN SAME LOCATION,60K BTU/96%AFUE
Work:
Owner Contractor
NANCY PATELLI BUILDER SERVICES GROUP INC
28743 CARMEL ROAD 475 N WILLIAMSON BLVD
MENIFEE,CA 92586 DAYTONA BEACH,FL 32114
Applicant phone:3863042222
ED PONCE License Number: 1034361
BUILDER SERVICES GROUP INC DBA TRUTEAM OF CA
475 N WILLIAMSON BLVD
DAYTONA BEACH, CA 32114
Fee Description -0-t( Amount(E)
Forced-Air or Gravity-Type Fumace or Burner 1 - 149.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Mechanical 1 7.45
$184.45
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_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 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 01 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 , -Z n License No./d.5 5 / By my signature below I acknowledge that,except for m p my personal residence
Expires4 0//y Signature .��Ga b� 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
❑1 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 forworker's 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for
by Section 3700 of the Labor Code,for the performance of work for which this application is submitted or at the following website:
this permit Is Issued. %vv%v.leginfo.ca.gov/calaw.html.
Policy# Date
have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT h T
section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I certify to each of the fallowing: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 A 6se- AdlAle a I C fi—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#4Z L-A_C ,rr0514L / Expires 41 3dl/ a enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less Date
PROPERTY OWNER OR AUTHORIZED AGENT
o 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#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's ompensation provisions of Section 3700 of the Labor
Code,1 shall forth # mply with ft o !rovisions. Will the applicant or future building occupant handle hazardous material or a
Applicant �C� / Date /.J//� mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes o No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN WIII the intended use of the building by the applicant Or future building
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY ❑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 ONO
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that 1 am exempt from the permitting checklist.I understand my requirements under the State of
Contractor's 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.
Business and Professions Code).Any city or county that requires a permit to DYes ❑No
construct,alter,improve,demolish or repair any structure,prior to its Date
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRP)
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 far 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 compensation
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 act childcare
facility to rental property than($Sao). q P p p rry owners and property
managers who do the paint-disturbing work themselves or through their
D I,as owner of the property,or my employee with wages as their sale 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 1-80"24-LEAD(5323).
Cade;The Contractor's 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:
❑I,as owner of the property am exclusively contacting with licensed
contactors to construct the project(Section 7044,Business and Professions
Cade:The Contractor's 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.
BUILDING & SAFETY PERMIT/PLAN CHECK A• • •
"Menifee
DATE 05/01/2018 PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA [-]SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION []DEMOLITION [-]ELECTRICAL BO MECHANICAL
[-]NEW ❑PLUMBING El RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Replace FAU only in same location.60KBTU/96%AFUE
City of Men•Ifee
PROJECT ADDRESS 28743 Cannel Rd aaeaj Building Dept.
ASSESSOR'S PARCEL NUMBER 337-222-014 LOT TRACT MAY O 12018
PROPERTY OWNER'S NAME Nancy Patelli ReCeived
ADDRESS 28743 Carmel Rd, Sun City, Ca 92586
PHONE (951)973-4575 EMAIL
APPLICANT NAME Edward Ponce
ADDRESS 475 Rivera St, Unit:D, Riverside, CA 92501
PHONE (951)683-4429 EMAIL
CONTRACTOR'S NAME Truteam of CA OWNER BUILDER? ❑YES❑✓NO
BUSINESS NAME
ADDRESS 475 Rivera St, Unit:D, Riverside, CA 92501
PHONE (951)683-4429 EMAIL
CONTRACTOR'S STATE LIC NUMBER 1034361 LICENSE CLASSIFICATION C20
VALUATION$ $3,000.00 SO FT 1400 L SQ FT
APPLICANT'S SIGNATURE DATE 57Z I /I
CITY STAFF USE ONLY -6offl-W, I
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING G ENGINEERING FIRE GREEN SMIP K
INVOICE IV4• � PAIDAMOUNT �j OCASH OCHECKk OCREDIT CARD VISA/MC
AMOUNT J
PLAN CHECK FEES PAIDAMOUNT v 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cltyofinenifee.us Inspection Request Line 951-246-6213
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