PMT18-03110 City of Menifee Permit No.: PMT18-03110
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 06/21/2018
PERMIT
Site Address: 27083 EMERALD COVE CT, MENIFEE, Parcel Number: 333-411-010
CA 92585 Construction Cost: $12,000.00
Existing Use: Proposed Use:
Description of REPLACE HVAC,5 TON A/C AND 88,000 BTU FURNACE
Work:
Owner Contractor
ESMERALDA LEON LUCKY AIR INC
27083 EMERALD COVE COURT 4049 BURGESS WAY
MENIFEE, CA 92585 RIVERSIDE, CA 92501
Applicant Phone:9516828573
NATHAN WALTERS License Number:836498
LUCKY AIR INC
4049 BURGESS WAY
RIVERSIDE, CA 92501
Fee Description O_yt Amount lSl
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 building 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_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. G the fallowing reason:
License Class? License No. ` .my signature below I acknowledge that,except for my personal residence
Expires / 3( /rd 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
❑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 following website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit Is issued. wwnv.leeinfo.ca.eov/calaw.html.
Polity q Date
o l 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 owners behalf.I have read this
number are: A application and the information I have provided is correct.I agree to comply
Carrier ksOC- with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy c�P3r�9 Expires /l Z / enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is or one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
D 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 0
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation v.sions ion 3700 of the Labor
Code,I shall forthwith comyl rovisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant ..%� Date 2 amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVE4AGE IS o Yes ❑No
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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR[ODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY D Yes ❑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) o Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I 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&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed nett to the applicable R hazardous material reporting.em(s)(Section 7031.5 oyes in No
Business and Professions Cade).Any city or county that requires a permit to Date
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 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 apre-1978
and the casts far the alleged exemption.Any ntviolation
to a civil
of Section of not o residence or childcare facility to be RRP-certified firms and comply with
thanApplicant for a permit subjects the applicant to a rivil 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
D 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 www.ena.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a
property who,through employees'or personal effort,builds or improves the D An EPA Lead-Safe Certified Renovator will be responsible for this project
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:
o 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code: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 APPLICATION
,Menitee
DATE: Otbn/h PERMIT/PLAN CHECK NUMBER
TYPE: COMMERCIAL X RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SP
SUBTYPE: O ADDITION (ALTERATION O DEMOLITION O ELECTRICAL O MECHANBoUding Dept.
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK Ce— T
l� Rece'rved
PROIECTADDRE55 27rj 3 C_j1rLej1LIj ZIP
ASSESSOR'S PARCEL NUMBER 333- LOT TRACT
OWNER NAME
ADDRESS �j
PHONE - - EMAIL
APPLICANT NAME S'
ADDRESS (' � sa�
PHONE U EMAIL
CONTRACTOR'S NAME 6 OWNER BUILDER? O YES J(NO
BUSINESS NAME �
C-
ADDRESS (�
PHONE 3 EMAIL
CONTRACTOR'S STATE UC NUMBER 8361/58 LICENSE CLASSIFICATION C Zc)
VALUATION$ 1r;yk- S r�Ca �� L SQ FT
APPLICANT'S SIGNATURE DATE Z/ / F,
UTYS oN ,
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENI FEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
PERMIT FEE SMIP GREEN I -
PLAN CHECK FEE INVOICE TOTAL (b
OWNER BUILDER VERIFIED O YES 0 NO DRIVERS LICENSE# NOTARIZED LETTER O YES NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.citVoj`menifee.us
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