PMT18-04950 City of Menifee Permit No.: PMT18-04950
29714 HAUN RD. T Residential Mechanical
MENIFEE,CA 92586 yam'
MENIFEE MENIFEE Date Issued: 1011112018
PERMIT
Site Address: 30739 TIERRA LINDA CT, MENIFEE, CA Parcel Number: 360491-031
92584 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, REPLACE 5 TON A/C& 110,00 BTU FURNACE, SAME LOCATION
Work:
Owner Contractor
DANNY CUMMINGS LUCKY AIR INC
30739 TIERRA LINDA COURT 4049 BURGESS WAY
MENIFEE,CA 92584 RIVERSIDE,CA 92501
Applicant Phone:9516828573
NATHAN WALTERS License Number:836498
LUCKY AIR INC
4049 BURGESS WAY
RIVERSIDE,CA 92501
Fee Description Qty Amount I51
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.
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CITY OF MENIFEE /JiV '
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 contractor(s)pursuant to the Contractors State License Law).
Chapters(commencing with section 7000)of Division 3 of the.Business and o I am exempt from licensure under the Contractor's Stale license Law for
Professions Code and my license is in full force and effect q the following reason:
License Class License No. ' ��L
---- By mysignatore below lacknowledge that,except far mypersonal residence
Expires 7 3f jS Signature in which I 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
o I hereby affirm under penalty of perjury one of the following declaration:) 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. ww..1eRinfo.ca.9ov/caIaw.html.
Policy If 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 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
Carrier elf— ( D- G� Ls/�dT with all applicable city and county ordinances and state laws relating to
7'
building construction.I authorize representatives of this city or county to
Policy k ft9)Q-,0y&;j,3611 Expires94� enter the above identified property for 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
O 1 certify that in the performance of the work for which this permit is issued,
Ishallnotemolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that"f d.hecome HAZARDOUS MATERIAL DECLARATION
subject to the workers compensa" ons ofravrsf— Section 3700 of the Labor
Code,I shall forthwith c wit ose provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant Date 47 YJ amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION&ERIAGE 15 ❑Yes o No
UNLAWFUL,AND SHALLSUBIECT 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 for guidelines
CONSTRUCTION LENDING AGENCY oyes ciNo
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 O No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that l am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License 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 items)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to Oyes o No
construcDate
issuance,also require s the
f rthep permit
to
a prior tsta 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(RRP)
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 apre-1976
and the basis for the alleged exemption.Any violation of Section 70315 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 orthrough their
a 1,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 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a aAn 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. 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 Ucense Law does not apply to an owner of a If your project does not comply wfth EPA RRP rule please fill out the RRP
Acknowledgement.
DATE: oi ba PERMIT/PLAN CHECK NUMBER
TYPE: :>COMMERCIAL PRESIDENTIAL MULTI-FAMILY -'• MOBILE HOME POOL/SPA SIGN
SUBTYPE! ADDITION AITFRATION r, DF1u10LMON FI.FI-TRICAL. *MFCHANICAI.
NEW : PLUMBING RE-ROOF NUMBER OF SQUARES 7 y
DESCRIPTION OF/WORK /( CL� OVL / /�/
PROJECT ADDRESS 2 % Z_1 a_ C ZIP ZRY
ASSESSOR'S PARCEL NUMBER 7j( 0-ft- QZ?\ LOT TRACT City of Menifee
Building Dept.
OWNER NAME
ADDRESS OCT 11 2018
PHONE - EMAIL '--�
Receivec
APPLICANT NAME /J S
ADDRESS C5701 (` 61
/
PHONE - EMAIL •—�
CONTRACTOR'S NAME '144-/ OWNER BUILDER? <--YES •NO
BUSINESS NAME r
ADDRESS
PHONE 7S EMA L —�
CONTRACTOR'S STATE LIC NUMBER rj3SV LICENSE CLASSIFICATION
h 1
VALUATIONS 0 FT L SQ�T
APPLICANT'S SIGNATURE DATE l f
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
D
BUILDING PLANNING ENGINEERING FIRE ACCEPTE BY:
PERMIT FEE , %o j
SMIP GREEN 1
PLAN CHECK FEE INVOICE TOTAL . 10
OWNER BUILDER VERIFIED %YES O NO DRIVERS LICENSE# NOTARIZEDLETTER •-+ YES C% NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityo(men ifee.us
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