PMT18-02989 City of Menifee Permit No.: PMT18-02989
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Mechanical
'
MENIFEE MENIFEE Date Issued: 0611812018
PERMIT
Site Address: 26471 TANGLEWOOD DR, MENIFEE, CA Parcel Number: 337-202-003
92586 Construction Cost: $4,500.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE FAU FURNACE ONLY-SAME LOCATION
Work:
Owner Contractor
PATRICIA FREEMAN BUILDER SERVICES GROUP INC
26471 TANGLEWOOD DRIVE 475 N WILLIAMSON BLVD
MENIFEE, CA 92586 DAYTONA BEACH, FL 32114
Applicant Phone: 3863042222
BUILDER SERVICES GROUP INC License Number: 1034361
475 N WILLIAMSON BLVD
DAYTONA BEACH, CA 32114
Phone: 3863042222
Fee Description ON Amount IS1
Forced-Air'or Gravity-Type Furnace 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_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds orimproves thereon,and who contracts forthe projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractors)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 Contractor's State License Law for
Professions Code and my license is in full force and effect. the fallowing reason:
License Class L—Z O License No, a9 ate+/5—/7 By my signature below I acknowledge that,except for my personal residence
Expires �130/f% Signature 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 worker's 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 fallowing websile:
by Section 370D of the Labor Code,for the performance of work for which
this permit is issued. www.leeinfo.ca.eov/calaw.html.
Policy If Date
X have and will maintain worker's 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 worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
numberare: application and the information I have provided is correct.I agree to comply
Carrier_Ac with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policytl 0 L.4 C 4Fn'i3!f/.t Expires Glanl/F 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 emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE ft C7
worker's 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 forthw, amply w/itb a provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant / cs t Date //��V1f-7 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 oYes iTNo
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 the
t(SCtionor See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY oYes two
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) o Yes VNo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjurythat i am exempt from the permitting checklist.I understand my requirements under the State of
California
Contractors License Law for the reason hazzardou
s)indicated below by the hazardous
Health al Safety Code,Section 25505 and 25534 concerning
u
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hs material reporting.
Business and Professions Code).Any city or county that requires a permit to oYes YNo /y/7
6 � w Date // -3 /
construct,alter,improve, applicantsh for the any permit to file,prior tostatement
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 1RRPT
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 for a permit subjects the applicant to a civil penalty of not more required radices.This includes rentalproperty
than($500). 4 P owners and property
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 sale employees.For more Information about EPA's Renovation Program visit:
compensation,will do( )all of ar( )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 1-80D-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a oAn 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 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.
BUILDING & SAFETY PERMIT/PLAN CHECKAPPLICATION /
41
"Menifee
DATE (11e'1/0 PER CHECKNUMBERPtI-MIR
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL MULTI-FAMILY ❑MOBILE HOME POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL QMECHANICAL
❑NEW ❑PLUMBINGAt ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK ftelaCII't � A U2YIQC u4i1 rvw- one n
PROJECTADDRESS 2.(0 -11 (An w00d ()Iz C;T2CCS(0
ASSESSOR'S PARCEL NUMBER 2-07 0ao ✓ LOT 2qC5 TRACT Zy 4(p
PROPERTY OWNER'S NAME +T VICI0. TY,QeMa,
ADDRESS -"1 dun �eoc� r City of Menifee
BtAd*ng Dept.
PHONEI��1 q—��1 J EMAIL
APPLICANT NAME r o U C C-
ADDRESS 475 Rivera St, Unit:D, Riverside, CA 92501
PHONE (951)722-6905 EMAIL
CONTRACTOR'S NAME Truteam of CA Inc OWNER BUILDER? ❑YESONO
BUSINESS NAME TruTeam of CA
ADDRESS 475 Rivera St, Unit:D, Riverside,CA 92501
PHONE (951)683-4429 EMAIL
CONTRACTOR'S STATE LIC NUMBER 1034361 LICENSE CLASSIFICATION C20
VALUATION$ Lt,500 SO FFTTT j 10q S L SQ FT
APPLICANT'S SIGNATURE DATE 6- Ar//Jr--
CITYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 1' SMIP o4oaC�l
INVOICE eI PAIDAMOUNT
AMOUNT IV OCASH 0CHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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