PMT18-03099 City of Menifee Permit No.: PMT18-03099
^l
,�4f 29714 HAUN RD.
MENIFEE, CA 9258E Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 06/2112018
PERMIT
Site Address: 28585 SAND ISLAND WAY, MENIFEE, CA Parcel Number: 364-131-031
92584 Construction Cost $5.000.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT,5 TON SPLIT SYSTEM, SAME LOCATION
Work:
Owner Contractor
JOHN PAGE KMA HVAC INC
28585 SAND ISLAND WAY 25920IRIS AVE 13A400
MENIFEE,CA 92584 MORENO VALLEY, CA 92551
Applicant Phone:8777178732
NATALIE LOPEZ License Number: 1023799
KMA HVAC INC
25920 IRIS AVE 13A-400
MORENO VALLEY, CA 92551
Fee Description Qtv Amount($1
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 I am under provisions of with a licensed contractors)pursuant to the Contractors State License Law).
Chapter9(commencing with section 700D)of Division 3 of the Business and o l am exempt from licensure under the Contractor's State License Law for
Professions Code and�my license is In full force and effect. �/ .�1 the following reason:
LicenLicense Cla s (,-�I Ucen e N OS-; `G C By my signature below I acknowledge that,except for my personal residence
ssy 'u0 Vl Signature in which l must have resided for at least one year prior to completion of
WORKER'S OMP NSATION DECLARATION improvements covered by this permit.lcannot legallysell a structure that)
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 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 following websile:
by Section 3700 of the Labor Code,for the performance of work for which avvnv.leeinfa.ca.eov/calaw.html.
this permit is issued.
Policyq Date
O I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Cade,for the performance of the work for which O By my signature below l 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 l have provided is correct.I agree to comply
Carrier /L'I�L-�/�.Il I` with all applicable city and county ordinances and state laws relating to
` building construction.I authorize representatives of this city or county to
Policy Expires L� enter the above identified property for inspection purposes.
(This section need not to be completed is the permit h for one-hundred Date
dollars($IUD)or less 00 PROPERTY OWNER OR AUTHORIZED AGENT t 1
o I certify that in the performance of the work for which this permit is issued, ®I 1 f��4E r_
I shall not emolav any persons in any manner so as to become subject to the CITY BUSINESS LICENSE q 40 °�Y�
worker's compensation laws of California,and agree that If I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. n Will the applicant or future building occupant handle hazardous material or
tt (t 1U mixture containing a hazardous material equal to or greater that the
Applicant �i.��4 ImA(Ifi��1T 1. Date amauntsspecified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION i10VERAGE IS ayes �No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applian[arfuture building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN
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 LAB OR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(5[AQMD)?See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY oYes ` 0
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) oYes 1}No
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
California Health al Safety Code,de,Section 25505 and 2553e concerning
Contractor's License Law for the reason(s)indicated below by the
hazardous material r ortin
checkmark(s)I have placed next to the applicable item(sJ(Section 70315 oYes INo r;
Business and Professions Code).Any city or county that requires a permit to \M(� Date `U
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 Contractor's State EPA RENOVATION.REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt from licensure The EPA Renovation,Repair and Painting fRRP)Rule requires preractars
receiving compensation for most work that disturbs paint in With
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to he RRP-certified firms and complyply 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 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 forsale.(Section 7044,Business and Professions 1-800424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a 0An EPA Lead-Safe Certified Renovator will he 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 Finn Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-guilder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
D I,as owner of the property am exclusively contracting with licensed
contractors 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 RAP
Acknowledgement.
K6L_W,tir_ Lpez- I�I�1� tVtfi�
APPLICATION
BUILDING & SAFETY PERMIT/PLAN CHECK
Menifee
DATE: U U b PERMIT/PLAN CHECK NUMBER p
TYPE: C COMMERCIAL C RESIDENTIAL C MULTI-FAMILY C MOBILE HOME C POOL/SPA C SIGN
SUBTYPE: C ADDITION O ALTERATION C DEMOLITION -- ELECTRICAL MECHANICAL
O NiE1W C PLUMBING C RE-ROOF NUMBER OF SQUARES-
DESCRIPTION 1
DESCRIPTION OF WORK 4fkV L� O pN'� LOG ON
100
PROJECTADDRESS % V 7 5"t) 16J �� - ZIP �1��•(J"l
ASSESSOR'S PARCEL NUMBER _apLA-j2?\0 b, LOT TR it l Of Menifee
OWNER NAME O � m cling Dept.
�/,q5
ADDRESS V V AI mv t SUN 21 2018
PHONE (nl% 4ist oo[o� EMAIL Rsarnin ..
APPLICANT NAME N fk'! i W 0' IvIvu
ADDRESS �J2. O L 5 N e _tr 1 k- {�y OO
PHONE ��I 4� y 0_1 ffjj -r EMAIL N fkj'
CONTRACTOR'S NAME M Ar 4 AG L OWNER BUILDER? C YES ONO
BUSINESS NAME
1t A^ �(J� �l {�/o 'A
ADDRESS /m/� ✓�a �/ I `y 1'CY {W CLO o J
PHONE A'�A gq)U EMAIL
e
CONTRACTOR'S STATE LIC NUMBER ���/�jlq,� LICENSE CLASSIFICATION Cf20
VALUATION $ 1 0 0 0 SO ` L SO FT rrnn
APPLICANT'S SIGNATURE DATE V 40 1�
DEPARTMENT DISTRIBUTION , ,n CITY OF MENIFEE BUSINESS LICENSE NUMBER
11�`.'11YJ1
BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY:
PERMIT FEE . , SMIP x GREEN I
PLAN CHECK FEE INVOICETOTAL ZO D
OWNER BUILDER VERIFIED C YES C NO DRIVERS LICENSE# NOTARIZED LETTER C YES C NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us
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