PMT18-03645 City of Menifee Permit No.: PMT18-03645
29714 HAUN RD.
/Zt MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 07/23/2018
PERMIT
Site Address: 27117 STARK ST, MENIFEE, CA 92586 Parcel Number: 335-305-008
Construction Cost: $13,680.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE-HVAC-INSTALL 2 TON HVAC 24,000 BTU WITH NEW IRS DUCTS
Work:
Owner Contractor
JERI WHIPPERMAN HASCO HEATING AIRCONDITIONING SERVICE
27117 STARK STREET COMPANY INC
MENIFEE, CA 92586 3015 DURAHART STREET
Applicant Phone:9516B23336
HASCO HEATING AIRCONDITIONING SERVICE COMPANY 41 License Number.519360
3015 DURAHART STREET
RIVERSIDE,CA 92507
Phone:9516823336
Fee Description OQt Amount f51
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
with a licensed contractor(s)pursuantto the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 70001 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 l p F U License N 5 / By my signature below I acknowledge that,except for my personal residence
Expires/y Sign in which 1 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. www.Ieginfo.ca.gov/caIaw.htmI.
Polity#
Date
PROPERTY OWNER OR AUTHORIZED AGENT
❑I have and will maintain worker's compensation insurance,as required by
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 owner's behalf.I have read this
number are: 1/rf/f application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
Policy# ,JSWGI Id 055/7V Expires 7 � � enter the above identified properyfor inspection purposes.
(This section need not to be completed Is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers comp n o To f Section 3700 of the Labor
Code,I shall forthwith c ith th Ions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date 7 �1 '/d mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
NING:FA LURE TO SERE WHO KER'S COMPENSATION COVERAGE IS ❑Yes ❑No
UNLAWFUL,AND SHALL SUBIELTAN 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 LIBOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑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 isissued outer boundary of a school?
(Section 3097 Civil Code) ` ev ❑Yes ❑No
OWNER BUILDER DECLARATIONS L+�1Ly 0�`v, Q6 I have read the Hazardous Material Information Guide and the SCAQMD
` permitting checklist.)and n equirements underthe State of
1 hereby affirm under penalty of perjury that I am It from the ttyy�Q California Health&Safe Co I n 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below I�I�,,,,aa,, 2U U hazardous materi
checkmark(s)I have placed next to the applicable iterSeLt 7031.5 oyes ❑N '�7
Business and Professions Code).Any city or county th requires a p%rmi t�� Date
construct,alter,improve,demolish or repair any structure,prior OOOVVV..///''' PERT1�"OWNER OR A RIZED AGENT
issuance,also requires the applicant for the permity♦,��'�l�e Ia��''`� j Ent
that he or she is licensed pursuant to the provision It1PfRlactars State EPA RENOVATION,REPAIR AND PAINTING(RRPI
License Law(Chapter 9(commencing with Section 7 0 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($500). managers who do the paint-disturbing work themselves cr through their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 70",Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or Improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
o I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: —// 2, PERMIT/PLAN CHECK NUMBER Pw0 - O'N
UF
GRADING/PLANNING CASE NUMB-E/R/OTHER RELATED CASES
TYPE: O COMMERCIAL G RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION PALTERATION. O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK ; y-( e-!C 4 I' rt-L Zyi jwOD/37
W
OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERS O YES O NO
PROJECTADDRESS IL7 7 BfatK 'St/.� ZIP r Z SS
ASSESSOR'S PARCEL NUMBER LOT TRACT
�35 . 3b5'•1�1.6
OWNER NAME T'er't rN►tt M(.1{-� ra
ADDRESS 2 7 7 SO'40. k S�
PHONE �6� YS[$'- G- yp EMAIL
APPLICANT NAME CA r A $ /7P t, •I lO
ADDRESS 3fJ/,� [-�. s x /1r 1 -
PHONE 957, 6p2- 333LT - EMAIL (in �^Jrj k4scoQC - Cb "A
CONTRACTOR'S NAME Ckrl S LFV ( � OWNER BUILDER? OYES OPRO
BUSINESS NAME H�.SCd
ADDRESS 3OI .S� l7VrtiH �T7`'
PHONE 9S! 611, 3 3 3 to [^ EMAIL
CONTRACTOR'S STATE LIC NUMBER 5�936 t7 LICENSE CLASSIFICATION C' Z O
VALUATION$ 13 6 . D p SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE 7/7
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITYOF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING EN NEERING FIRE ' 1
INVOICE TOTAL 32N ,Iy GREEN SMIP
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES C NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofmenifee.us
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