PMT18-04017 City of Menifee Permit No.: PMT18-04017
29714 HAUN RD.
sIlAr MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 08/14/2018
PERMIT
Site Address: 29554 WAGON CREEK LN, MENIFEE, CA Parcel Number: 339-414-013
92584 Construction Cost: $10,200.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE AC ONLY; NO HEATING COMPONENTS ALTERED
Work: 14 SEER
Owner Contractor
ERIC GENTILE TEMECULA VALLEY HEATING&AIR
29554 WAGON CREEK LANE 41804 HUMBER DR
MENIFEE, CA 92584 TEMECULA, CA 92591
Applicant Phone:9516762162
TEMECULA VALLEY HEATING&AIR License Number:597999
41804 HUMBER DR
TEMECULA, CA 92591
Phone: 9516762162
Fee Description gty Amount ISI
Air Handling/Condensing Units SFR 1 133.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 2.00
General Plan Maintenance Fee-Mechanical 1 6.65
$142.65
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
I hereby affirm under penaltyef perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 70001 of Division 3 of the Business and a 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 212 ao jdcense No. ?ep//D`^ By my signature below I acknowledge that,except for my personal residence
Expires CIL Signatur in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION Improvements covered by this permit.I cannot legally sell 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 a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for workers 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 ww.leeinfo.ca.eov/calaw.html.
this permit is Issued. w
Policy# Date
a I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which a 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 are: application and the information I have provided is correct.I agree to comply
7 with all applicable city and county ordinances and state laws relating to
Cartier bulldIng construction.I authorize representatives of this city or county to
Policy Expires t he abgve identified property for inspection purposes.
jj(Jt
(This section need not to be completed is the permit is for one-hundred (/]�L V 0o,16L1u-- Date L_50_)
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
AI 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 orkers compensation provisions of Section 3700 of the Labor
Code,I sh rrthwlth c mply ww�ii/th�,those revisions. I Will the applicant or future building occupant handle hazardous material or a
Applica L l:4(IAII' Date -3�-�8' mixture containing a hazardous material equal to or greater that the
amounts ecified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ayes KNo
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 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forgutdelfnes
CONSTRUCTION LENDING AGENCY ayes KNo
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 bouoary of a school?
(Section 3097 Civil Code) ayes KBO
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors Ucense 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(s)(Section 7031.5 hazardous at 'al reporting.
Business and Professions Code).Any city or county that requires a permit to ayes el 'j e_,DA Jam,p Date I ✓��� fJ
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY O NER 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 IRRPI
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 casts or a e alleged exemption.ctsthe
Any violation of Section of not o residence or childcare facility to be RRP-certified firms and comply with
than
Applicant fora permi[subjetts the applian[toacivil penalty of not more required practices.This Includes rental property owners and property
than($500), managers who do the paint4sturbing work themselves or through their
a 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.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-900-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a D 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. D No EPA Lead-Safe Certified Firm is required for this project because:
a 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 RII out the RRP
Acknowledgement. 1
Lov �►oodw"- to Tl
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: - I PERMIT/PLAN CHECK NUMBER �V
GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: O COMMERCIAL i RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
(O_ NEW O PLUMBING O RE-ROOF F NUMBER OF SQUARES
DESCRIPTION OF WORK C/ 'e /p C chl
OCCUPANCY GROUP CONSTRUCTION�TY"PE SPRINKLERS O YES ` NO
PROJECTADDRESS ��SJrI� �[p 1 jn (I,Vl,-L ytk-) ZIP
ASSESSOR'S PARCEL NUMBER ? .1. � O LOT TRACT
OWNER NAME 'rL
ADDRESS/]` �/66�/ V)/L�, Yl
PHONE %y �` /(,� 7` �V�C.( � (11� �
EMAIL Tivc-4nV' o . n
APPLICANT NAME yru .((�° Vt, - 00dW6U1
ADDRESS t y- {r, I-lu kyaoj6L
a �Yr 6a�i
PHONE �`j /�'�/p -a-l/(a- EMAIL TO � ` G kwfn-I(I,Uf L1
CONTRACTOR'S NAME1-iry'-Culh. p d ✓ OWNER BUILDER? OYES �(NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER 90) LICENSE CLASSIFICATION (2 ,170
VALUATION$ U IV SQ�.FT L SO FT
APPLICANT'S SIGNATUR i IAA.)x `pC DATE
'�TY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY;Cfj� CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL 2„ 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., Mre*elkf Ji&dRW (9S1)672-6777
www.cityofinenifee.us Building Dept.
/-06 14 2018 NIF
Received
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