PMT18-03072 City of Menifee Permit No.: PMT18-03072
29714 HAUN RD.
Jr MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 06/20/2018
PERMIT
Site Address: 28762 MILKY WAY,MENIFEE,CA 92586 Parcel Number: 339-163-001
Construction Cost: $3,500.00
Existing Use: Proposed Use:
Description of HVAC-REPLACE COIL ONLY
Work:
Owner Contractor
MAURICIO SEMINARIO BEAR CREEK HEATING AND AIR CONDITIONING
28762 MILKY WAY INC
MENIFEE, CA 92586 24069 CHATENAY LANE
Applicant Phone:9516002882
BARRY DUNGAN License Number:779461
BEAR CREEK HEATING AND AIR CONDITIONING INC
24069 CHATENAY LANE
MURRIETA, CA 92562
Fee Description ON Amount 1S1
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 Bidg_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
1 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 1 am exempt from Iicensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. rr..��� (� the following reason:
License Class Czr) I se No. ZZ'"t A \ By mysignature below I acknowledge that,except formy personal residence
Expires 513i /2C) 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
o I hereby affirm under penalty of perjury one of the fallowing 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.leginfo.ca.eov/calaw.html.
Polity# 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 ofthe 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: application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and stale 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($300)or less
PROPERTY OWNER OR AUTHORIZED AGENT
I cerilfy that in the performance of the work for which this permit is issued, �f
I s II not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE If ���_�a I v
workers compensation laws of California,and agree that if 1 should become HAZARDOUS MATERIAL DECLARATION
subject to the workers comperl an rovisions of Section 3700 of the Labor
Code, all rthwith coca yv)w h th rauictoas,�. Will the applicant or future building occupant handle hazardous material or
Applicant i Date mixture containing a hazardous material equal to orgreater that the
amounts cified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes , lo
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 construction
modification
checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forCoast
Ai`rlines
Q�ua
CONSTRUCTION LENDING AGENCY ❑Yes 3<io
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within LOGO 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) 0Yes )111�0
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAOMD
1 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 Health al Safety Code,Section 25505 and 25539 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.
Business and Professions Cade).Any city or county that requires a permit to J�. . to
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHdhIZED AGENT
issuance,also requires the applicant for the permit to Rle a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRPI
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 apre-1978
and the basis for the alleged exemption.Any violation of Section 70315 by residence compenor sation
facility to he RRP-certified rums and comply with
than
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 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 wwv.eoa.aov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-BOD-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. D No EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner ofthe 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 rill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE's
il�' A A-
DATE: PERMIT/PLAN CHECK NUMBER
PLANNING CASE NUMBER
TYPE: O COMMERCIAL NESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION ALTERATION O DEMOLITION Ct ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECT ADDRESSZ(:Z1k`Z pAL� �f`,ti1„y ,}� +� ZIP
ASSESSOR'S PARCEL NUMBER �i I�Q3��JD' LOT TRACT 11 'ems
OWNER NAME
ADDRESS
PHONE �U _ �, `�� . EMAIL
APPLICANT NAME /�
ADDRESS 2 �1� U(��`�^Q ,- C4
PHONE EMAIL i
CONTRACTOR'S.NAME y� OWNER BUILDER? O YES kNO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER � �� LICENSE CLASSIFICATION
VALUATION$ �j�Q SO FT L SQ FT
APPLICANT'S SIGNATURE DATE
OTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: /,�j CITY OF MENI BUSINf1,jENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE ` / �(/jh`]•(V�
INVOICE TOTAL I ' GREEN ' SMIP
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE N NOTARIZED LETTER 0 YES O NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofinenifee.us
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