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PMT15-02544 i City of Menifee Permit No.: PMT15-02544 29714 HAUN RD. ' c;k�Jam' MENIFEE, CA 92586 Type: Residential Mechanical MENIFEE Date Issued: 08/20/2015 i PERMIT Site Address: 28931 W WORCESTER RD, MENIFEE, Parcel Number: 339-141-010 CA 92566 Construction Cost: $6,170.00 Existing Use: Proposed Use: Description of HVAC CHANGE OUT, 3-TON A/C, 70,000 BTU FURNACE Work: Owner Contractor , RAMZI HANNA MONKS AIR CONDITIONING 28931 W WORCESTER ROAD P O 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 l3yt Amount - sR�S4�.`fl�oT G�a�itv�vR rDac 17f•B :` i 0 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 Bldg_Permit Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLA8MON I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with lice Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044,Business and Profes Professions my license is in full ice nd . Code:The Contractor's License Law does not apply to an owner of a pro ; License Class. .1 LicenseN who builds or Improves thereon, and who contracts for the projects x Explre-z-ILLJ6 Signatu licensed contactor(s)pursuant tD the Contractors Sete License Law). WORKERS'COMPENSAT)ON DECLARATION ❑ I am exempt from Iloensure under the Contractors'State License Law t 5' ❑ I hereby affirm under penalty of perjury one of the following dederations: following reason: --- I have and will maintain a certificate of consent of setHnsure for workers' By my signature below I acknowledge that,except:for my personal resider compensation,Issued by the Director of Industrial Relations as provided for by which I must have resided .tor at least one year, prior to oomplett Sedan 3hll.of'the Labor Code,for the,perli mancO of work for which this improvements covered by this permit,I cannot.legaly sell a structure that I permit is issued. bulk as an ownerbuilding if it has not been constructed in Its entirety by Ilo Policy# oci tractors. I understand that a copy of the applicable law,Section 7044 O I have and will maintain workers' compensation insurance, as required by Business end Professions Code,Isavailable upon request when this applies section 3700 of the labor Code, for the performance of the work for which this submitted or at the following Web site:hftD:llwww lealnfo ce.aovfceMaw.html. permit Is Issued.My worrk�k-^e+rs+ 'compensation insurance Cartier and policy number are: Carder !'�' 4 ��/ roperty Owner or o ate.D Expires _r Ice Policy# �•' /CO i 2- 1-� Name of Agent Phone# ❑ my Signature below, I the to each of the following: I am the car owner r or auNmortzed to act onn ire property owners behalf. I fwve tee (This section need la be completed if the pemdt is for application and the info ' rre on I have provided is tad. I agree to c one-hundred dollars($T00)or less) with all appfi iota city unity ordinances and state laws relating to b construdio reserd9tivas of this city or county to enter the m ❑ I certify that in the,performance of the work for which this,permit is Issued,I identified arty t in action purposes, shall pgtimWov any persons in any manner so as to become subject to the workers'compensation laws of Celifomia,and agree if I should became subject to the workers'compense of n 3700 of the Labor P ner Authorized nt Date Code,I shall forthwith comply with those Vons. City Business License# _ Date; APP(I WARNING: FAILURE TO SECURE WORKERS' TERLALDECLARATION 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 BUILDII ($100,0(M),IN ADDITION TO THE COST OF-COMPENSATION, oS OCCUPANT HANDLE A HAZARDOUS MATERIAL 01 DAMAGES AS PROVIDED FOR IN t3EI31 I 4706 OF THE M=URE CONTAINING A HAZARDOUS MATERI LABOR CODE,INTEREST,AND ATTORNEYS FEES EQUAL TO OR GREATER THAN THE AMOUN 2nuaropCTIOµLENDINGAC,ENCY SPEOIFIED ON .THE HAZARDOUS MATERIA INFORMATION GUIDE? I hereby affirm that under the penalty of perjury there Is a construction lending agency for the performance of themotic which this permit Is issued (Section WILL THE INTENDED USE OF THE BUILDING BY 1 3097 CMI Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQU Lender's Name OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATI �v,� FROM THE SOUTH COAST AIR QUALITY MANAGEME T Lender's Address "O DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST f GUIDE LINES OWNER BUILDER 12ECLAPMONS i hereby affirm under penalty of perjury that I am exempt from tie Contractors PRINT NAME: License Law for the reason(s)indicated below by the checkmark(s)I have placed AYES WILL THE PROPOSED BUILDING OR MODIFIED FACIL next to the applicable item(s)(Sed on 7031.5.Business and Professions Code: rmh BE WITHIN 1000 FEET OF THE OUTER BOUNDARY C Any city or county that requires a permd to construct,alter,improve,demolish, 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 provislonsof The Comradoes State License Low(Chapter 9(commencing with I HAVE READ THE HAZARDOUS MATEF Section 7000)of Division 3 of the Business and Professions Code)or that he or >#S INFORMATION GUIDE AND THE SCAQMD PERMIT she is exempt from floensure and the basis for she alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREME violation of Section 7M1.5 by any Applicant for a permft subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAf a civil penalty of not more then($500).) CODE B S IIO14 255�LS OR�1'ING D 25534 CONCERI D I, as owner of the property, or my employees with wages as their sole compensation,will do( )all of or( )porting of the work and the structure is P UTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractors State License Law does not apply to an owner of a property who, through employees or personal effort, builds or Improves the property, provided that the improvements are not Intended or altered for sale.if,however, the building or improvement is soli within one year of completion.,the Owner- Builder Will two the burden of proving that it was not built or improved far the purpose of sale). APPLICATIONBUILDING & SAFETY PERMITI/PLAN CHECK Bcilding & Safety Dept. ��Menifee AUG 2 0 2015 DATE PERMIT/PLAN CHECK NUMBER Oa5 ved TYPE: O COMMERCIAL I RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL��KMECHANICAL O NEW1 / O PPLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK / /q t L . +-OyN � (� -70 �/- PTO Fur-no PROJECTADDRESS Lotv1_-v�r 2ZGif ASSESSOR'S PARCEL NUMBER t_")\,O LOT 3 Z TRACT Z Z OWNER NAME , //�� (� ADDRESS L/I e,( � 6 3 PHONE O&c) 2-6 - 1 0 N EMAIL APPLICANT NAME /���E ( �{ jr ^ r1k /�p �p /+� /��7 ADDRESS /��JcVt / �n M U�� 1`• 1 l_,! I j T-Lt (Dq `�1 G-5R PHONE (` 51 ) 4p7q-If I f502 � EMAILrnonKSal►-� lY1Gl,L.I , cbrn CONTRACTOR'S NAME U � I� 1 vl QrLK OWNER BUILDER? O YES XNO BUSINESS NAME G J r nd 'o n ' ADDRESS J/ I .n GA q-25 4 PHONE (CiM (,p-7 4 q- 2 EMAIL mOnksdtr Z 9kyta;_L - GDm CONTRACTOR'S STATE LLI7 IC NUMBER �/ 2 11/y LICENSE CLASSIFICATION C2Q VALUATION$ � / [0 SO FT ( L SO FT APPLICANTS SIGNATURE � DATE VjCITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN 1 SMIP INVOICE PAID AMOUNT AMOUNT �`� )\ 0 OCASH OCNECK# OCREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-572-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 w m N E 0 oc a n F O O u N V ti O 0 ^ =.r��i O cli a u a w > n N N o E QD � V x v c a c m o N O N Z r v � a a _ c � C c C c Z V u O W h m c x w > E Ex w w v y E a W 4,A Oa y Yo a ry 2 1° o N > L O O O O C ca 'k2 �/1 N o E E a u � V E tw u ¢ a c a - _ > U F 3 v E a J c � a a y `°' aEr w i a o 9 m o > c ° u s u E u Y 12 m E 3 a E o °H r E m o E am c c ¢` > ti t7 0 a a .n o m N C' N S N �L 01 a O ON O F.:. C E Q YVI E Q rl 1A Q U T q W O Q., Q •' a LL U o in o a m p m L m C C � U .�.. 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