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PMT18-03694 City of Menifee Permit No.: PMT18-03694 29714 HAUN RD. Type: Residential Mechanical '0 MENIFEE, CA 92586 MENIFEE MENIFEE Date Issued: 07/26/2018 PERMIT Site Address: 28533 RIVER GLEN CT, MENIFEE, CA Parcel Number: 364-146-061 92584 Construction Cost: $5,000.00 Existing Use: Proposed Use: Description of HVA CHANGE OUT,3 TON,90,000 BTU FURNACE, SAME LOCATION Work: Owner Contractor MARICRIS SANTIAGO KMA HVAC INC 28533 RIVER GLEN COURT 25920 IRIS AVE 13A400 MENIFEE, CA 92584 MORENO VALLEY, CA 92551 Applicant Phone: 8777178732 NATALIE LOPEZ License Number: 1023799 KMA HVAC INC 25920 IRIS AVE 13A400 MORENO VALLEY, CA 92551 Fee Description 01t rr Amount f$1 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 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 I hereby affirm under penalty of perjury that 1 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 a I am exempt from Ilcensure under the Contractor's State License Law for Professions Code and my license is In full force and effect. . the following reason: License Class w r��G r ,, �ht 'Ucenl�e�N1I �1(Z� ` � By my signature below l acknowledge that,except formy personal residence Expires1- u0 Cl Signature v � in which l must have resided for at least one year prior to completion of P WORKER'S OM NSATION DECLARATION��u °��o improvements covered by this permit.I cannot legally a structure that I have built as an owner-builder if it has not been constructed in its entirety by a 1 hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that copy of the applicable law,Section have and will maintain a certificate of consent of self-insure forworker'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 webslte: by Section 3700 of the Labor Code,for the performance of work for which this permit is issued. wr.Ay,leeinla.ca.eov/calaw.html. Policy 11 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 a By my signature below l 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 number are: ,/Ls, application and the information 1 have provided is correct.I agree to comply Carrier / l,c'LILI't l� '- with all applicable city and county ordinances and stale laws relating to ` building construction.I authorize representatives of this city or county to PoliryO ` LikA Expires 1 enter the above fdentified property for inspection purposes. (This section need not to be completed is the permit k for one-hundred Date dollars($100)or less h PROPERTY OWNER OR AUTHORIZED AGENT o I certify that in the performance of the work for which this permit is issued, 1 r+v� 1 shall not em ® olov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE q 4o worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the warker's compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. �n Will the applicant or future building occupant handle hazardous material or a /i v (� v mixture containing a hazardous material equal to or greater that the Applicant �`A I A1T �Y'Imo_Date amounts specified an the Hazardous Materials Information Guide? WARNING:FAIWRETO SECURE WORKER'S COMPENSATION OVERAGE IS oyes ,}'No UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant orfuture 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 CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY ayes 14No 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) a Yes )}No OWNER BUILDER DECLARATIONS 1 have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury thatlam exempt from the permitting checklist.I understand my requirements under the Sate of Contractor's License Law far the reason(s)indicated below by the California Health al Safely Code,Section 25505 and 25534 concerning hazardous material r portin checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 fj Business and Professions Code).Any city or county that requires a permit to oyes TNo&AR2 Date 'V 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 fRRPI License Law(Chapter9(commencing with Section 7o00)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contactors Business and Professions Code)or that he or she is exempt from licensure receiving compensation for mast 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 renal property owners and property than($5DD). managers who do the paint-disturbing work themselves or through their o1,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.eov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-BOG.424-LEAD(5323). Code,The Contractor's State License Law does not apply to an owner of a oAn 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. in No EPA Lead-Safe Certified Firm is required for this project because: ❑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. . i�ointc.g��eF�nr,�arRkur ai.AN. HECK;nRQMnTiOW MENIFEE 1 G E FET DATE: PERMIT/PLAN CHECK NUMBER GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES TYPE: O COMMERCIAL O RESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN SUBTYPE: (F)ADDITION O ALTERATION O DEMOLITION O ELECTRICAL ECHANICAL ANEW ()PLUMBING ORE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK I ` v % L Yo -b.® toa pK Mv OCCUPANCY GROUPSCONSTRUCTION TYPE SPRINKLERS©YES ONO PROIECTADDRESS -(I`{l� Zf p t-lvtA2 (AXOW (/I ZIP quim ASSESSOR'S PARCEL NUMBER aYL4 4w- 01 1 LOT TRACT Ci;Y Of Menifee OWNERNAMEI�I 50 1IM Q Building Dept. ADDRESS st JUL 26 2018 PHONE q;1 f91q — 14" EMAIL Received r Q/ 4AW 1` I ` APPLICANT NAM�E�Ap N Or' ' ADDRESS � r/ Jj 400 00 PHONE `%j !%W 001 EMAIL CONTRACTOWSNAME K `_ h VWI% OWNERBUILDER? ©YES®NO BUSINESS NAME //r�W�/� J5 A,/� ADDRESS ✓c LV4v Af j PHONE A�EMAIL CONTRACTOR'S STATE LIC NUMBER lO V%�W"1 LICENSE CLASSIFICATION V W VALUATION$ 060 S FT L SQ FT APPLICANT'S SIGNATURE DATE `o 1, w CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE ob INVOICETOTAL jC? GREEN 1— SMIP �t OWNER BUILDER VERIFIED 0 YES 0 NO DRIVERS LICENSE# NOTARIZED LETTER C YES G NO City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777 www.cityofmenifee.us rAmIlex NIF ny n c 03 o 0 0 0 o n n D v D n m °O X N to 9 O V to w t+ N r r m 2 M N Z Ct n o N m 3 d m 3 a D o o Z o n j 0 3 3 O G. •G .Oe On O O N 3 J m m r O O < m " Q oO�i m m 3 n O T A N• r 3 m 3 j w .. o J .J. 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