PMT15-01000 City of Menifee Permit No.: PMT15-01000
29714 HAUN RD.
4 CCE1L MENIFEE, CA 92586 Type: Residential Mechanical
Msun,�" MENIFEE Date Issued: 04/20/2015
PERMIT
Site Address: 27366 CALLE BALSERO, MENIFEE, CA Parcel Number: 336-271-007
92586 Construction Cost: $5,250.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, SPLIT SYSTEM, 70,000 BTU FURNACE, 2.5-TON A/C
Work:
Owner Contractor
DIANNA BARRY MONKS AIR CONDITIONING
27366 CALLE BALSERO P 0 BOX 128
MENIFEE, CA 92586 SUN CITY, CA 92586
Applicant Phone: 9516794502
TIFFANI SELLERS License Number: 912194
MONKS AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description ,O�tr Amount I$1
Air Handling/Condensing UnitsSFR 1 133.00
I' tlb ure �" 1
GREEN FEE 1 1.00
$310.00
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_Templatesirt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with license(
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professiom
Professions Co f�¢ d my license Is In full rce and eff . Code:The Contractor's License Law does not apply to an owner of a propert,
License
�77Clas�ss��t�-T� b License N _�� ,_ .,. . .. _ who builds or Improves thereon, and who contracts for the`projects with i
Explre�LYr Signatur licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION ❑ 1 am exempt from licensure under the Contractars'State License Law for th
❑ f hereby affirm under penalty of perjury one of the following declarations:
following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except.for my personal residence 1
compensation,Issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion c
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I hav
permit is issued. built as an owner-building If it has not been constructed in its entirety by license
Policy# contractors. I understand that a copy of the applicable law, Section 7044 of th
❑ 1 have and will maintain workers' compensation Insurance, as required by Business and Professions Code,is available upon request when this application
section 3700 of the Labor Cade, for the performance of the work for which this submitted or at the following Web site:htto�flwww legfnfo ca aovtgalaw html.
permit Is issued.My workers'compensation Insurance carrier and policy number are:
r^ ,(i f-�+F Property wrier or uthonze Agent Date
Carver 5
Expires �I I Policy
❑ By my Signature below, I cerfify to each of the following: I am the proper
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read tr
(This section need not be completed if the permit is for application and the Info ion have provided is correct. I agree to comf
one-hundred dollars($100)or less) with all applicable city a on
ordinances and state laws relating to huildh
constructlo . oriz r presentativeis of this city or county to enter the abov
❑ I certify that In the performance of the work for which this,permit is issued,I identified r erty f t inspection as
shall not employ any persons In any manner so as to become subject to the J—I'7
workers' compensation laws of CalE
and agree th if I should become
subject to the workers'compensatisio of Se ' n 3700 of the Labor. Pro ner Authorized Agent Date
Code,I shall forthwith comply with toyi ons. G
City Business License# 1 Q
Date; .\pplic
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, []YES OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON .THE HAZARDOUS MATERIALS
INFORMATION GUIDE?
I hereby affirm that under the penalty of perjury there is a construction lending
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ❑NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS PRINT NAME:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the reason(s)indicated below by the checkmark(s)I have placed AYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s) (Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, ❑NO SCHOOL?
or repair any structure, prior to Its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the I HAVE READ THE HAZARDOUS M AT E R I AI
provisions of the Contractor's State License Law (Chapter 9 (commencing with ❑YES
Section 7000)of Division 3 of the Business and Professions Code)or that he or INFORMATION GUIDE AND THE SCAQMD PERMITTIN(
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY .REQUIREMENT!
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFET'
a civil penalty of not more than($500).) COZD,ARDO CTI ON 25150 RE 5533 G D 25534 CONCERNIN(
❑ I, as owner of the property, or my employees with wages as their sole
compensation, will do ( ) all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not Intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property
who, through employees' or personal effort, builds or improves the property,
provided that the Improvements are not intended or offered for sale. If,however,
the building or Improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
BUILDING
♦ SAFETY PERMIT/PLAN
1 CHECKAPPLICATION
*Menifee APR 2 0 2015
d
DATE PERMIT/PLAN CHECK NUMBER -p
TYPE: O COMMERCIAL KRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O' POOL/SPA O SIGN
SUBTYPE: OADDITION 'ALTERATION O DEMOLITION - ELECTRICAL kMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK C
VA—C�r: 70,10no Kry Goof.. '• 3o�ov� �l� CZ-s T'o>^,
PROJECiADDRESS Z Q 110
ASSESSOR'S PARCEL NUMBER 336Z --YIo0-3- LOT 23 TRACE 3
OWNER NAME
ADDRESS /�(7 ( , Z
PHONE(q,�)5gl- '/ 366 y� EMAIL I'GZ-h1IYI 0 .G
APPLICANT NAME r u' 1��► L�f� /�Q [gyp /+,� /��7
ADDRESS /��JVS/�On M U r I I �.7 ' I Let �-f'1 `�1 !►�JF114
PHONE /%���•+'502 V I A EMAII-rnon�G�S01r0 ►Y�t� • [brn
l..{
CONTRACTOR'S NAME 0,! / Da—K OWNER BUILDER? O YES kNO
BUSINESS NAME MonL i t Cond 'l o n /�
ADDRESS ( GAL 5 4
PHONE �`�///�� S 50 LO 6-- 4,502- EMAIL mOnicSC4ir Z rna.-L . GDm
CONTRACTOR'S STATE LIC NUMBER q12 1cN LICENSE CLASSIFICATION C2.0
VALUATION$ 2 !�O— SO FT Ct qR- L SQ FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE P 5AID AMOUNT '] `� `
AMOUNT 6 CASH 0 CHECK# �CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD 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
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