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PMT15-01169 City of Menifee Permit No.: PMT15-01169 29714 HAUN RD. A� CCEt—A> MENIFEE, CA 92586 Type: Residential Mechanical s .w wk., MENIFEE Date Issued: 05/05/2016 PERMIT Site Address: 29327 CARMEL RD, MENIFEE, CA 92586 Parcel Number: 338-072-032 Construction Cost: $6,100.00 Existing Use: Proposed Use: Description of HVAC CHANGE OUT, SPLIT SYSTEM, 70,000 BTU FURNACE, 3-TON A/C COIL Work: Owner Contractor LOUISE CORTS MONKS AIR CONDITIONING 29327 CARMEL ROAD P 0 BOX 128 MENIFEE, CA 92586 SUN CITY, CA 92586 Applicant Phone: 9516794502 TIFFANI SELLERS License Number: 912194 MONKS AIR CONDITIONING PO BOX128 SUN CITY, CA 92586 Fee Description q�t Amount 1$1 +•+o �rapm^xw :^.,;rvmm-Q z �s v=�asca+. rem.' ot'edI[o.r G�rav�l =�r�e RLTrn aixr Buf�,nDr,, ,x� �� d z � ��pp" Air Handling/Condensing Units SFR 1 133.00 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_Bidg_Permil_Template.rpt 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 Professior Professions 9pd my license Is in full roe and etfla Code:The Contractors License Law does not apply to an owner of a propen License Class _( License N `7 _ _ who builds or improves thereon, and who contracts for the projects with Expirelz__? r Signatu licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARATION ❑ I am exempt from Ilcensure under the Contractors'State License Law for it ❑ I hereby affirm under penalty of perjury one of the following declarations: following reason: I have and will maintain a certificate of consent of seff4nsure for workers' By my signature below I acknowledge that, except for my personal residence 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 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 ha- 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 e ❑ 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 Code, for the performance of the work for which this submitted or at the following Web site:htto�/Avww leainfo ca aovlcalaw html. permit is issued.My workers'compensation insurance carder and policy number are: r'+ Property Owner or Authorize Agent Date Cartier t� (1/� Expires — Policy# I Z_1 D 1 I ❑ By my Signature below, I certify to each of the following: I am the grope Name of Agent Phone# owner or ardhoraed to act on the property owner's behalf. I have read t (This section need f4 be completed if the permit is for application and the info on I have provided is cored I agree to com one-hundred dollars($100)or less) with all appii bla city a unty ordinances and state laws relating to build constructio . oriz r presentatives of this city or county to enter the abo, ❑ I certify that in the performance of the work for which this,permit is issued,I identified erty f ins ed1.n purposes. shall not employ any persons in any manner so as to become subject to the �' = workers'compensation laws of Cal'rfomia, and agree th 'rf I should become subject to the workers compensation provisic- of Se n 3700 of the Labor pro er Authorized Agent Date Code,I shall forthwith comply with those pr cans. 5 / C City Business License# x _ Date; J .1pPli 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, OYES 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 ONO EQUAL TO OR GREATER THAN THE AMOUNTS CONSTRUCTION LENDING AGENCY SPECIFIED ON .THE HAZARDOUS MATERIALS I hereby affirm that under the penalty of perjury there is a construction lending INFORMATION GUIDE? 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 OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address ❑NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOF 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 OYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY next to the applicable ftem(s)(Section 7031.5.Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF P Any city or county that requires a permit to construct, after, improve, demolish, ONO 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 MATERIA provisions of the Contractor's State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or OYES 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 permft subjects the applicant to ❑NO UNDER THE STATE OF CALIFORN[A HEALTH AND SAFET a civil penalty of not more than($500).) - CODE SECTION 25505 25533 AND 25534 CONCERNIN ❑ I, as owner of the property, or my employees with wages as their sole HkNbOUS MATERIAL AEPORI'ING. compensation,will do( )all of or( )porting�of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). BUILDING & SAFETY • APPLICATION 'Menifee DATE —/ , PERMIT/PLAN CHECK NUMBER — TYPE: O COMMERCIAL *ESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME O POOVSPA O SIGN SUBTYPE: C ADDITION O ALTERATION O DEMOLITION O ELECTRICAL MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES CRYenifee Building & S fety Dept. DESCRIPTION OF WORK 5PX,sT S Sn'v n "O L- , .,-\ MAY 0 2015 PROJECT ADDRESS Lam/ Z� �� r}�� QaQff& Received ASSESSOR'S PARCEL NUMBER 3 3F10-1 Z 0 3.Z LOT TRACT 2� V OWNER NAME W ADDRESS L 2,7 2 PHONE(1Sa) .723 8520 EMAIL APPLICANT NAME ADDRESS V&u60 rM 1JV M p 7 I L t Ct-) CI 51g PHONE (q5/) a;7q--j5o2 p EMAILrnonKSAI✓'� . Corn CONTRACTOR'S NAME C �1! I V I t�{2�K^ J OWNER BUILDER? O YES NO BUSINESS NAME C M061<!� I r Cond 1 'o n 1 ADDRESS /� S ( "l2.rj `f PHONE (q5/� 6;-7q, 45©2. EMAIL monkSair c,D "-ILCL L . Gam CONTRACTOR'S STATE LIC NUMBER P12I9y LICENSE CLASSIFICATION C20 VALUATION$ /06 0000 SQ FT r -A No-O 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 I PAIDAMOUNT - C: AMOUNT CASH OCHECK# CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC OWNER BUILDER VERIFIED 0 YES O NO DL NUMBER NOTARIZED LETTER O YES 0 NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92585 951-672-6777 www.citycfinenifee.us Inspection Request Line 951-246-6213 pw N E N w DO LC] a N ¢ O p N p A� >• v N V �! H _m C'V y i0 U-) Nr. C N O LL CD V v D06 > v Y O. 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