PMT18-03273 City of Menifee Permit No.: PMT18-03273
29714 HAUN RD.
Air MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 0612912018
PERMIT
Site Address: 26171 SUNNY SIDE CT, MENIFEE, CA Parcel Number: 360-531-028
92584 Construction Cost: $12,000.00
Existing Use: Proposed Use:
Description of REPLACE 4 TON AC&88K BTU FURNACE-SAME SIZE AND SAME LOCATION
Work:
Owner Contractor
JENNIFER THOMPSON LUCKY AIR INC
26171 SUNNY SIDE COURT 4049 BURGESS WAY
MENIFEE, CA 92584 RIVERSIDE, CA 92501
Applicant Phone:9516828573
LUCKY AIR INC License Number:836498
4049 BURGESS WAY
RIVERSIDE, CA 92501
Phone:9516828573
Fee Description QQt rr 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.rpl 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 7000)of Division 3 of the Business and O 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 License No. y-my signature below l acknowledge that,except for my personal residence
Expires 7 l /S Signature in which I must have resided for at least one year prior to completion of
improvements covered by this permit.)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 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 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. www.leeinfo.ca.eovtcalaw.himl.
Polity g 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 ❑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.)have read this
number are: ®® f A application and the Information I have provided is correct.I agree to comply
Carrier L �t 4 7i'S:Sd C- with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policyll Expires ///L !fJ enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is or one-hundred
dollars($100)or less Dale
PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
1 shall not employ any persons In any manner so as to become subject to the CITY BUSINESS LICENSE If
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation pro 'sipjn of Section 3700 of the Labor '
Code,I shall forthwith comp) rovisions. /- L' Will the applicant or future building occupant handle hazardous material or a
Applicant �� Date fo U 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 COV14AGE IS ❑Yes a No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,0001,IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Duality Management heconDistrict(SCtionor See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Airlines
Qua
CONSTRUCTION LENDING AGENCY oYes oNo
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agencyfor the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) a Yes O No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCADMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item hazardous material reporting.$)(Section 7031.5 oYes D No
Business and Professions Code).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[!censure 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 faflir�to beork that distuffled rbs
s poirs andicomre-197ply h
thanApplicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($SOD).
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 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 vnvw.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered forsale.(Section 7044,Business and Professions 1-SDO-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 o An EPA Lead-Safe Certified Renovator will he 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. o No EPA Lead-Safe Certified Firm is required for this project because:
❑I,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 dam not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
.`
W-111t"I
®-Ek rl ee
DATE: Ip Q PERMIT/PLAN CHECK NUMBER WM_M~MV 197
TYPE: -"COMMERCIAL RESIDENTIAL MULTI-FAMILY . MOBILE HOME ' POOL/SPA .SIGN
SUBTYPE: ADDITION XALTERATION . DEMOLITION -- ELECTRICAL MECHANICAL
NEW --.- PLUMBING RE-ROOF NUMBER OF SQUARES 1
DESCRIPTION OF WORK r �
PROJECT ADDRESS ZIP q
ASSESSOR'S PARCEL NUMBER LOTf TRACT
OWNER NAME
ADDRESS Scmnv C Ci
PHONE sai22 EMAIL
APPLICANT NAME //
ADDRESS 320/
/ ���vY��[( (� J
PHONE ( - W — EMAIL
CONTRACTOR'S NAME OWNER BUILDER? YES `NO
BUSINESS NAME rL ! C-
ADDRESS f /
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER &32X( C ) LICENSE CLASSIFICATION
VALUATION S SQ FT - - ( Q FT
APPLICANT'S SIGNATURE DATE L4 /rCJ
GTYSTAFF USER0AlY .n_
DEPARTN,ENT DISTRIBUTION CITY OF M1ENIFEE BUSINESS LICEN5E NUMBER
BIRLDLNG PLANNING EqglNEERING FIRE ACCEPTED BY %IbW
PERMIT FEE SMIP GREEN I
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED YES NO DRIVERS LICENSE# NOTARIZED LETTER YES NO
City Of f dGmifee
Buildin0 ++
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586�Q e o97-6777
www.Cityofinenifee.us JUN 2 9 2018
Received
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City Of Menifee
Building Dept.
JUN 2 4 2018
Pn Received