PMT18-03600 City of Menifee Permit No.. PMT18-03600
IF AW ff 29714 HAUN RD.1 MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 0 7/1 912 01 8
PERMIT
Site Address: 31134 LARCHWOOD ST, MENIFEE,CA Parcel Number: 372-012-012
92584 Construction Cost: $5,000.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, 3 TON 70,000 BTU FURNACE,SAME LOCATION
Work:
Owner Contractor
PORFIRIO LUNA KMA HVAC INC
31134 LARCHWOOD STREET 25920 IRIS AVE 13A-400
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 City Amount IS)
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 carded on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise staled,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_Bktg_Permit Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
hereby affirm under penalty of perjury that I am under provisions of with a licensed contrector(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 700D)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. 2�1 the following reason:
License Chi s 4 rwr�� Ucen eNa Z% `�C By my signature below l acknowledge that,except formy personal residence
Expires� 'j'r'O "t Signature� in which I must have resided for at least one year prior to completion of
WORKER'S OMPNSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that)
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 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 anvsv.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy q Date
D 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 ❑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.I have read this
numberare: ,,�� �s� application and the information l have provided is correct.I agree to comply
Carrier u-I�7 L lTLLt` ^ with all applicable city and county ordinances and state laws relating to
r ` building construction.l authorize representatives of this city or county to
Policy it VLPii:MOE� q`ln—T Expires l� enter the above Identified property for inspection purposes.
(This section need not to be completed is the permit for one-hundred Oate-
n ($100)or less 444444 PROPERTY OWNER OR AUTHORIZED AGENT
l certify that in the performance of the work for which this permit is issued, ®1 1 rPa�
I shall not emolav any persons in any manner so as to become subject to the CITY BUSINESS LICENSE h �l
worker's compensation laws of California,and agree that If I should became HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material ora
., mixture containing a hazardous material equal to or greater that the
Applicant �i.�TA IYhA(.G�YI I.� Date w 'V
�— amounts specified an the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION OVERAGE IS 0Yes �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(SCAQMDI?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES 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 he 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) ❑Yes 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 penaltyof perjury that I am exempt from the
Contractor's License Law for the reason(s)indicated below by the California Health alSafety Code,Section 25505 and 25539 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material r porttn
oyes ;fNo
Business and Professions Code).Any city or county that requires a permit to rl
construct,alter,improve,demolish or repair any structure,prior to its II� Date `U
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING LRRP)
License Law(Chapter9(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( j 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 for sale.(Section 7044,Business and Professions 1-BOD-424-LEAD(5323).
Code;The Contractor's Sate License Law does not apply to an owner of a aAn EPA lead-Safe Certified Renovator will be responsible far this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offeredfor 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:
o 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 plea se rill out the RAP
�, ` Acknowledgement.
BU ILDI NIS & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
Q e
DATE: l PERMIT/PLAN CHECK NUMBER g Dept
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA ffi§IGVqQ
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW�PaO PLUMBING O RE-ROOF NUMBER
,OFSQUARES _•,
DESCRIPTION OF WORK Y 1 CiTI' Q j l7 Frly Y �G�' 1pY�
PROJECTADDRESS % ZIP
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAM�E/ ' ` Yfi 1 O L-U I {A
ADDRESS
PHONE gn 7j✓���' °i"I'� EMAIL
APPLICANT NAAM,E�j �N Pr I 1-1( LA �ql�s p,a
ADDRESS `(I`l9 t I�I� Lf bO
PHONE �t 1�� V��?1 EMAIL
CONTRACTOR'S NAME M Pry ai, OWNER BUILDER? O YES O NO
BUSINESS NAME
ADDRESS '�' "p(/nn� l V7 0 PV L'IM 11 OK,No IIJ '
PHONE °� I `L+� U 4115�1 9.� EMAIL
CONTRACTOR'S STATE LIC NUMBER to IlU��4 LICENSE CLASSIFICATION
VALUATION$ "/L6o3 SOFT LSQFT
APPLICANT'S SIGNATURE kN DATE
CITY STAFF USE ONLY �t
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIFE
PERMIT FEE �'a, .1O SMIP GREEN I
PLAN CHECK FEE INVOICETOTAL 0
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofrnenifee.us
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