PMT18-05042 City of Menifee Permit No.: PMT18-05042
10 29714 HAUN RD.
fffMENIFEE,CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 1011812018
PERMIT
Site Address: 29764 GIFHORN CT, MENIFEE, CA Parcel Number: 339-252-014
92584 Construction Cost: $3,000.00
Existing Use: Proposed Use:
Description of REPLACING FAU FURNACE ONLY SAME LOCATION 60K BTUS 3 TONS
Work:
Owner Contractor
NIZAR HASAN BUILDER SERVICES GROUP INC
29764 GIFHORN CT 475 N WILLIAMSON BLVD
MENIFEE, CA 9 DAYTONA BEACH, FL 32114
Applicant Phone:3863042222
EDWARD PONCE License Number: 1034361
BUILDER SERVICES GROUP INC
475 N WILLIAMSON BLVD
DAYTONA BEACH, CA 32114
Phone:9517226905
Fee Description ON Amount($1
Forced-Air or Gravity-Type Furnace or Burner 1 149.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Mechanical 1 7.45
$184.45
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_Pennit_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 I 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 o I am exempt from licensure under the Contactors State License Law for
Professions Code and my license is in full farce and effect the following reason:
License Class 1K —2[_7 License J// By my signature below I acknowledge that,except for my personal residence
Expires 30//7 Signature � i=GG•i.L 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 declarations:I licensed contactors.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
this permit is issued, www.leginfo.ca.gov/calaw.htmi.
Policy a Date
�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 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 owners behalf.I have read this
numberare: 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 ("G= /7 6( r- r=r Lz iT building construction.I authorize representatives of this city or county to
Policy# 14) �`✓'->kf**f Expires �1��/7 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 I certify that in the performance of the work for which this permit is issued,
Shall not emolUV any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# V�+•rd^ L
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthtt itccomply with hps provisions. 'Aill the applicant or future building occupant handle hazardous material or
Applicant - <�^ Date Sj"� /� mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURETO SECURE WORKER'S COMPENSATION COVERAGE IS ci Yes 6 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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY ❑Yes "'r..
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) D Yes cvbo
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 penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable items)(Section 7031.5 ciYes 'sfNo /
Business and Professions Code).Any city or county that requires a permit to `��� Date � 'p(
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 Contactors 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 contactors
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 mare required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
n I,as owner of the property,or my employee with wages as theirsole 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 Contactors State License Law does not apply to an owner of a o 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 bemuse:
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
E % c^ n 7R I,�� Acknowledgement.
BUILDING & APPLICATIONCHECK
Menifee
DATE PERMIT/PLAN CHECK NUMBER MT I O
TYPE: El COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOUTION [-]ELECTRICAL ❑✓ MECHANICAL
❑NEW []PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK REPLACING FAU FURNACE ONLY SAME LOCATION
PROJECT ADDRESS 29764 GIFHORN CT
ASSESSOR'S PARCEL NUMBER 339-252-014 LOT 17 TRACT 23314
PROPERTY OWNER'S NAME NIZAR HASAN
ADDRESS
PHONE ��C �Q�j-. 'J� � EMAIL
APPLICANT NAME -'Do ,,L%0
ADDRESS 475 Rivera St, Unit:D, Riverside, CA 92501
PHONE (951)722-6905 EMAIL
CONTRACTOR'S NAME Truteam of CA Inc OWNER BUILDER? ❑YES ✓❑NO
BUSINESS NAME TruTeam of CA
ADDRESS 475 Rivera St, Unit:D, Riverside, CA 92501
PHONE (951)683-4429 EMAIL
CONTRACTOR'S STATE LIC NUMBER 1034361 LICENSE CLASSIFICATION C20
VALUATION$ $3,000.00 SQ FT L SQ FT
APPLICANT'S SIGNATURE �— DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I0e10 SMIP
INVOICE PAID AMOUNT
AMOUNT OCASH OCHECK it OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT I OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd, Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
rl
qQ
\ ( ($ 7 |
mct
� } ! 0 \
-
\
- (
�\ {
-
- �
( \ - ` M m 9; \ / / ( _
> -
° &
{ i / }
90
\ § � `
\ § ( ! } } \ \
\ E \
� } \ � ¢
D T T X : OD_ n
m T ry
w w w O O ~ 1 O f7
w ° 3 n? Z 'G •G N A A O A j m 3 F+ O 3 D
Z M m
3 O
ri
j Oo O O T O ^ O » n d = II N * N m 9
m j O
n O �
� II II a ° A d '� m .• ° ? a D
n w m q o u n ? w 1E < n m
L1 O j
A a °
D II II o n m n •. � 2 c O d m W .� H
o lmG m w m m' aEn
m m f q c > > ? £ a In N
o y C � n "w m � T •G �. d O p �
O e•r a d '-' � m m > > �
�m o d N A
F
N
e 0 w' n d n O m
'° '^ d 3 N m O m 3 ^ w m 2
a. 3� m w o� ' � = ' d � a < 300 a n
0 3
m m
ow v� �• vi x o m n .- a
w 0 p 0
n-
m ° a M
� o O II O n 0
o n
3 n '30 00 D O
0 _ m V n m m j m
m ^ 'm a w A II !C W
,my v .. .. v! n m > >
0 O < Qp
� N �
N N
O3
y N C ID 3 o 'O
�..� -3 N =O 00 m n C 0G
p < 3
of -
d
3 o S A
v vi
x
o O O O M c
m S
D " O
^ m m n � m m Z
a x T a o m m
o yAi Q o a O O
W v m o Oca n `
r
o 0 .. n
ry 9 V v m m
= F+Z l d A
n
L 0 A m w
M. � �
A m �
w C N N
0 O
A y m o m
K W N
N r6
vn Nn -in mz ;a va f+ D m0
D w O r< � Nn C 3 � .o N F 7 Nn c 3 j c OO » m
a ,d_, t n a E m 3 a S 7 m 3 `
< a m m< m ' -'�i'. m o n
�+ D L '° _ _ti
m n.
M _ a
O c ¢
< y < O Z c N m v 3 N < O o en 9 n
N d 3 C S d R O J O R 3 d N N fD
w
o gw nm N m a D
0
o c N
3 c g 3 0 "' 3 m n n
N T
� » m
o GO
m o
t� o
,dm n
..
v ^ n
N C N O
d a N C
N6 O
A p N ¢ O — ti p
d G N<
m
W
S > 3 A A N
W W
EF
J T c a m .d.
n �
s = v m w
� m
d as sS
s
p n o d m a
vl m
N o m
A " r
ao _
„ A
D
'm Z9 ° w m