PMT18-05403 City of Menifee Permit No.: PMT18-05403
29714 HAUN RD. Type: Residential Mechanical
MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued: 11/13/2018
PERMIT
Site Address: 27942 TATE RD, MENIFEE, CA 92585 Parcel Number: 336-480-004
Construction Cost: $10,981.00
Existing Use: Proposed Use:
Description of REPLACE FURNACE 90K BTU AFUE .8
Work:
Owner Contractor
HERBERT HELM W C HEATING&AIR CONDITIONING INC
27942 TATE RD. 41085 GOLDEN GATE CIR
MENIFEE, CA 92585 MURRIETA, CA 92562
Applicant Phone: 9516000700
MITCH BLUMAN License Number: 779604
W C HEATING &AIR CONDITIONING INC
41085 GOLDEN GATE CIR
MURRIETA, CA 92562
Fee Description City Amount($)
Forced-Air or Gravity-Type Furnace or Burner 1 149.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
GREEN FEE 1 0.00
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_Perm it—Tern plate.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 contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)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. u the following reason:
License Class CZO Li e se N 77%0 I By my signature below I acknowledge that,except for my personal residence
Expires 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
❑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 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.htm1.
7Po icy# Date
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 ❑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 Q:e,S -S. G, with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# l tr 1 CW'\90 7 Cj�3 Expires 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
❑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#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's ompensation provisions of Section 3700 of the Labor
Code,I shall f wit c ply with those provisions. ' Will the applicant or future building occupant handle hazardous material or a
I I ; g mixture containing a hazardous material equal to or greater that the
Applicant Date ` amounts s cified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION OVE GE IS ❑Yes r�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 Qu lity Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guideli s
CONSTRUCTION LENDING AGENCY ❑Yes No
I hereby affirm that under the penalty of perjury there is a construction Will the pr osed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer bou dart'of a school?
(Section 3097 Civil Code) ❑Yes No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting c ecklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California ealth&Sa ty Code,S
mat ial p r ing.
ection 25505 and 25534 concerning
r
Contractor's License Law for the reason(s)indicated below by the hazardou t
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ❑yes N '�
o
Business and Professions Code).Any city or county that requires a permit to I
�' -
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT Date 6
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(RRP)
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 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 or 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.epa.gov/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 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
completion,the Owner-Builder will have the burden of proving that it was Firm Certification No.:
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
[11,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.
Building Dii- -;,.
,.�
DATE: �,(�� (C� PERMIT/PLAN CHECK NUMBER17"t
A >Q
TYPE: 0 COMMERCIAL RESIDENTIAL O MULTI-FAMILY O' MOBILE HOME
SUBTYPE: `ADDITION ALTERATION O DEMOLITION O ELECTRICALMECHANICAL
NEW PLUMBING ORE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECT ADDRESS L��I`t 2 �p�ke ZIP
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME 14e4 beck �Ae-k`M C
ADDRESS 27442 'r0<K- �2-� • J t`r Q4,
PHONE Ar)i 5-71- `J 1� '-1 h EMAIL
APPLICANT NAME JAV+L,\ 'ja()A,-"4n
ADDRESS j�'�- -� ' iJ� �'r- It 2�� W� Ia` C* " ,to �JkZ-
PHONE ' �3rj��y l EMAIL
CONTRACTOR'S NAME �yrca (y4'3j!' U��l OWNER BUILDER? OYES ONO
BUSINESS NAME �0.f
ADDRESS LikD% � �j( . l"lU��f s�¢,�a Cl 6 Zkl
PHONE �� 'r� 1D� EMAIL
CONTRACTOR'S STATE LIC NUMBER ��W LICENSE CLASSIFICATION ?A
VALUATION$ j �`S I SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE t
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
D emBUILDING PLANNING ENGINEERING FIRE ACCEPTE BY:
PERMIT FEE ' 3� SMIP GREEN
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED 0 YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES 0 NO
CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page I of 3)
Project Name: HERBERT HELM Date Prepared: 2018-11-13
A.General Information
CF1R-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit.When multiple dwelling units must be documented, use one
CF1R-ALT-02 document for each dwelling unit.
01 Project Name HERBERT HELM 02 Date Prepared 2018-11-13 city O i 1 �
FAuildinq Dap
03 Project Location 27942 TATE ROAD 04 Building Type Single family
05 CA City Sun City 06 Dwelling Unit Name HERBERT HELM
07 Zip Code 92585 08 Dwelling Unit Conditioned
1792 Oda
��r®�
Floor Area(ft ) v
Number of Space
09 Climate Zone 10 10 Conditioning(SC)Systems in 1
this Dwelling Unit:
B. Space Conditioning (SC)System Information
01 02 03 04 05 06 07 08 09 10
Is the SC Installing a
SC System SC System CFA served system a refrigerant Installing new SC Installing Installing Installing
Identification or Location or Area by this SC ducted containing system more than 40 entirely new entirely new
Name Served System (ft) system? component? components? feet of ducts? duct system? SC system? Alteration Type
System 1 Location 1 1792 Yes No Yes No No No Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet(Section150.2(b)1Diib)
This section does not apply to this project.
403
Registration Number:418 A020089631A-000 000 0000000-0000 Registration Date/Time:2018 1PFFICE
08:29:04 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2018.0.001 Report Generated:2018-11-13 08:29:04
Schema Version:rev 20180426