PMT18-03441 City of Menifee Permit No.: PMT18-03441
29714 HAUN RD.
Type: Residential Mechanical.1 MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued: 0 711 112 01 8
PERMIT
Site Address: 25360 FOREST WOOD CIR, MENIFEE, Parcel Number: 339-383-024
CA 92584 Construction Cost: $6,600.00
Existing Use: Proposed Use:
Description of INSTALL NEW 3.5 TON HVAC SYSTEM
Work:
Owner Contractor
WINNIE BRISCOE FAMILY PLUMBING HEATING&AIR INC
25360 FOREST WOOD CIR 34629 FOX BERRY ROAD
MENIFEE, CA 92584 WINCHESTER, CA 92596
Applicant Phone:9516994488
LORI WOODWARD License Number.918182
FAMILY PLUMBING HEATING&AIR INC
34629 FOX BERRY ROAD
WINCHESTER, CA 92596
Fee Description Qtv Amount 151
Forced-Air or Gravity-Type Furnace or Burner 2 298.00
Air Handling/Condensing Units SFR 2 266.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Mechanical 1 28.20
$620.20
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_aldg_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractors)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
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. the following reason:
License Class/C a'U ld ense'N,o.. / p'/ O al By my signature below I acknowledge that,except for my personal residence
Expires 0—✓(� Signatur W In which I must have resided for at least one year priorto 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
o reby 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 www.leginfo.ca.gov/calaw.htmi.
this permit is issued.
Policy#
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 of the 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 art: , '' ^Q- application and the information I have provided is correct.I agree to comply
Carrier I.(�V with all applicable city and county ordinances and state laws relating to
G building construction.I authorize representatives of this city or county to
Policy# WG IJ O xpires lUna(,L—) X enterthe above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($1DO)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that In the performance of the work for which this permit is Issued, 75
1 shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should became HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I she f h ith mplywIth those provisions. �1 Will the applicant or future building occupant handle hazardous material or a
Applican Date mixture containing a hazardous material equal to or greaterthatthe
amounts s ified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 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 37060F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guideliJ es
CONSTRUCTION LENDING AGENCY in Yes 7, 0
1 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 boun ary of a school?
(Section 3097 Civil Code) ❑Yes dNo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazar ous aterial reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Ye o t 7
Business and Professions Code).Any city or county that requires a permit to OJOV �- Date /(-1 H
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 Contractors State EPA RENOVATION,REPAIR AND PAINTING[RRPI
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 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 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 www.eoa.aov/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 Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovatorwlll be responsible forthis 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-Builder 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:
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
' ^n 4 r4 _ _ J — ,_' / _ "r � Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK AP
PLICATION iv MENIFEE
DATE: -t l' () PERMIT/PLAN CHECK NUMBER
GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: 0 COMMERCIAL ® RESIDENTIAL (F)MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: (F)ADDITION ()ALTERATION ®DEMOLITION () ELECTRICAL Q MECHANICAL
()NEW ®PLUMBING ORE-ROOF NUMBER {OF SQUARES
DESCRIPTION OF WORK o.Q{'l ^I- L f j 5J'• 6-6{) A (i
OCCUPANCY GROUP �1 CONSTRUCTION TYPE SPRINKLERS OYES ®NO
PROIECTADDRESS 9S�I�U �Gj7�r yQ(Cf t' V• ZIP p
ASSESSOR'S PARCEL NUMBER !J@ � _ �iJ��OO SLOT 1 TRACT �I
OWNER NAME U)I V)n I 6 /-�Y L?/ 6o
ADDRESS d66 /5tt(./� �f / 0y`e iL PJMA
PHONE I EMAIL -
APPLICANTNAME -evz k t �a t`b&J�K - I n pa'vp ,� (/�
ADDRESS a {m (o rn'�✓V l 2-l��t ` '� 1
PHONE ?Lt&- LQgz NS EMAIL Id ul�V'1 , ,
CONTRACTOR'S NAME ("J2''V1Cd,-µled V��I• OWNER BUILDER? Q ®YESNO
BUSINESS NAME {� o 'ff II
ADDRESS vn Q
PHONE pC((1-�y / 7j aC{ j EMAIL
CONTRACTOR'S STATE LIC NUMBER Otis I LICENSE CLASSIFICATION
VALUATION$ SQ FT L SQ FT
APPLICANT'S SIGNATU DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEEUSINESS LICENSE NQWR
BUILDING PLANNING ENGINEERING FIRE '( 75
INVOICETOTAL b'>,o � GREEN `` SMIP
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586(951)672-6777
www.c i tyofm e n i fee.us
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