PMT18-02975 City of Menifee Permit No.: PMT18-02975
AR AR
AFVW MENIFEE,
EE, C 92 Type: Residential Mechanical
MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued: 06/1512018
PERMIT
Site Address: 27505 SUN CITY BLVD, MENIFEE, CA Parcel Number: 335-180-018
92586 Construction Cost: $11,961.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE 14 SEER AFUE HVAC SYSTEM
Work:
Owner Contractor
DAVID DAMANSKE W C HEATING&AIR CONDITIONING INC
27505 SUN CITY BLVD 41085 GOLDEN GATE CIR
MENIFEE, CA 92586 MURRIETA,CA 92562
Applicant Phone:9516000700
W C HEATING&AIR CONDITIONING INC License Number. 779604
41085 GOLDEN GATE CIR
MURRIETA, CA 92562
Fee Description Chit Amount!$)
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_Permit_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 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 ❑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 L. O Li e se Na Q-ILBy my signature below I acknowledge that,except for m g g p y personal residence
Expires_Signature in which I 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 DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
a 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.eov/calaw.htmL
Policy# W=:T � Date
0I 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 ❑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.I agree to comply
S? with all applicable city and county ordinances and state laws relating to
Carrier /- / building construction.I authorize representatives of this city or county to
Polity# J spires —���9 *RERTY
abov entified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred �AW/�
dollars($1GO)or less Date
OWNER OR AUTHORIZED AGENT
0I certify that in the performance of the work for which this permit is issued, ®3J a I shall not employ 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 mpensation provisions of Section 3700 of the Labor
Code,I shall with o ply with those provisions. ` Will the applicant or future building occupant handle hazardous material or a
Applicant Date (fJ /S—/8 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 o Yes p[Nci
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
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
forguid��`elllls ine
/
CONSTRUCTION LENDING AGENCY oYes p.No
I hereby affirm that under the penalty of perjury there is a construction Will theproposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit Is issued outer bou dary of a school?
(Section 3097 Civil Code) 0 Yes X0
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 1 am exempt from the
Safety Code,Section 25505 and 25534 concerning
Contractor a s License Law for the reason(s)indicated below by the California Health
checkmark(s)I have placed next to the applicable items)(Section 7031.5 hazardous material reporting.
No /—
Business and Professions Code).Any city repair
that requires a permit to )Will �,�m j1�d Dated
construct,alter,improve,demolish or repair any structure,signets to PRO 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 licensure 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 fora 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 -
01,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 711",Business and Professions 1-800-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a D 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:
❑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 fill out the RRP
Acknowledgement.
Koh &vl m M1 4
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION _, r; MEN IFEE
DATE: PERMIT/PLAN CHECK NUMBER 1 la 0-2-9
PLANNING CASE NUMBER
TYPE: 0 COMMERCIAL YRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL AMECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK
3 ' cloo eomofgfe VA(f
PROJECTADDRESS ��(G/� (�C�` �l(� ZIP
ASSESSOR'S PARCEL NUMBER J✓• LOT TRACT
OWNER NAME 'D�yid D vNinske,
ADDRESSn?, ���� ud
YT PHONE /)s(p 7-///�A (/ f
EMAIL
APPLICANT NAME Keik /,�, �✓
ADDRESS 3Ia�s`" �, • •(A/ (� �1D
PHONE - EMAIL
CONTRACTOR'S NAME wec�epl OWNER BUILDER? Q YES NO
BUSINESS NAME �(
ADDRESS 8 J
PHONE �) (p co - 0 7� EMAIL
CONTRACTOR'S STATE LIC NUMBER 7 1M to LICENSE CLASSIFICATION rQD
VALUATION$ SO FT L SO FT /
APPLICANT'S SIGNATURE DATE
OTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: �r CITY Of MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE 1V1`..J1 7�
INVOICE TOTAL �u. GREEN 1 ,OD SMIP
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
nay of enifee
City of Menifee Building & Safety Department 129714 Hagd t#I36QA e, CA 92586 (951)672-6777
WWW.cityofinenifee.us _ "TM "
JUN 15 2018 ENIFE a
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