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PMT15-02545
City of Menifee Permit No.: PMT15-02545 29714 HAUN RD. 4:i�d MENIFEE, CA 92586 Type: Residential Mechanical MENIFEE Date Issued: 08/20/2015 PERMIT Site Address: 27230 PALOMA WAY, MENIFEE, CA Parcel Number: 336-011-018 92586 Construction Cost: $8,260.00 Existing Use: Proposed Use: Description of HVAC CHANGE OUT, 3-TON A/C, 60,000 BTU FURNACE Work: Owner Contractor ADELINE KLEMPNER MONKS AIR CONDITIONING 27230 PALOMA WAY 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 QtV Amount 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 DECLARATION I hereby affirm undo r'penalty or perjary that I am Iloensed under pric sions 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 Profess ProfessionsCo�g�nd my license is in full roe and effe Code:The Contractor's License Law does not apply to an owner of a pro License I as.E '.L,f:L License N I 4 who builds or Improves thereon, and who contracts for the projects m Expire-,13LL .6 :SEgnatu -.... . .. licensed contractors)pursuant to the Contractors State License Law). WORKERS'COMP Ns TION DECLARAT)ON ❑ 1 am exempt from lioensure under the Contractors'State License Law B ❑ I hereby affirm under penalty of perjury one of the following declarations: following reason: I have and will maintain a cenficate of consent of seNMM for workers' By my signature below I acknowledge tihst,exc ept,fcr my personal residei compensation,issued by the Director of Industrial Relations as provided for by which I must have resided .for at. least one yew, prior to complain Section 371)0 of the Labor Code,for the performance of work for which this Improvements covered by this permit,I cannot.Jegally sell a structure that I permit Is Issued. built as an owner-building if it has not been oonstruded in Its entirety by Ilo Policy# - contractors. I understand that a copy of the applicable law, Section 7044 ❑ 1 have and will maintain workers' compensation insurance, as required by Business and Professions Code,is aval'able upon request when this applice section 3700 of the Labor Cade for the per fammice of the work for which this submitted or at the following Web site:htta•IAnvw leelnfo ce eavlea fI html. permit is Issued.My workers'compensation Insurance canter and policy number are: roPe'rtY owner or. o Agar - Date Expires -Policy# 12•" !UJ 2^ i 7e .. Name of Agent Phone# ❑owner my Signature below, I n iffythe to each of the folis beha: i am to rez owner or ardhorized to act on tire properly owner's behalf. I have res (This section need pg$be completed if the permit Is for application and the into on I have provided Is correct. I agree to c one-hundred dollars($100)or less) with all appill bie city uray ordinances and state laws relating to b constructio IasenfaCvas of this city or county to enter the r ❑ I certify flit in the performance of the work for which this,permit is Issued,I Identified I 'co purposes. shell Pot emnlov any persons In any manner so as to become subject to the workers'compensation laws of California,and agree If I should become _ subject to the workers!compensation provisio ;of Se n 3700 of the Labor. P er Authorized Agent � Date Code,I shall forthwith comply with those p tons. �y � City Business License#� Date; �pPII. WARNINGc FAILURE TO SECURE WORKERS' HAJ18120US NIATFRIAL DECLSR®TION - 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 ($100,000), IN ADDITION TO THE COST OF.COMPENSATION, - OYES OCCUPANT HANDLE A HAZARDOUS MATERIAL Of DAMAGES AS PROVIDED FOR IN StCTtOtml`'3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERI LABOR CODE,INTEREST,AND ATTORNEYS FEES �0 EQUAL TO OR GREATER THAN THE AMOUN r'-^uUCT10N ENDINGAGEuCY SPECIFIED ON .THE HAZARDOUS MATERIA I hereby affirm that under the penalty of perjury there Is a construction lending INFORMATION GUIDE? agency for the performance of the mork which this permit Is issued (Section WILL THE INTENDED USE OF THE BUILDING BY 1 3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQU Lender's Name ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATI FROM THE SOUTH COAST AIR QUALITY MANAGEME Lender's Address 0 DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST F GUIDE LINES OWNER BUILDER DECLARRAVQNS I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME: License Law far the reason(s)Indicated below by the cheekmark(s)I have placed DYES WILL THE PROPOSED BUILDING OR MODIFIED FACIL next to the applicable Item(s)(Section 7031.5.Business and Professions Cade: ;w, BE WITHIN 1000 FEET OF THE OUTER BOUNDARY C Any city or county that requires a permit 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 I HAVE READ THE HAZARDOUS MATES provisions of the Contractors State License taw(Chapter 9 (commencing with Section 7000)of Division 3 of the Business and Profess!=Code)or that he or S INFORMATION GUIDE AND THE SCAQMO PERMIT she is exempt from Gcensure and the basis Tor the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREME violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAf a civil penalty of not more than($500).) CODE SECTION 25505 33 AND 25534 CONCERI ❑ 1, as owner of the property, or my employees with wages as their sole H07 bOUS MATERIAL ORTING. compensation,will do( )all of or( )porting of the work,and the structure Is P W UTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License taw does not apply to an owner of a property who, through employees' or personal effort, builds or improves the property, provided_that the improvements are not Intended or offered for sale.If,however, the building or improvement is sold within one year of completion,the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). BUILDING & SAF ETY PER MITI/PLAN CHECK APPLI CATION ;OMenifee DATE / PERMIT/PLAN CHECK NUMBER - TYPE: O COMMERCIAL AIESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION 0 ELECTRICAL -><MECHANI , City of Me ifee ding & Saf ty Dept. O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK 4+J0r, LLaLq UM -�IG 1 2015 K pw-lJ eJ ry)a cb _ O E)d PROJECT ADDRESS 2 2 I[jp�rll(� ` ASSESSOR'S PARCEL LNNUMBER 77� b l O` d LOT Z -\ TRACT �O 2 OWNERNAME I 1 ILII ) `,- ADDRESS PHONE N EMAIL APPLICANTNNA/MME (�{ r►� ^ + 1v ^ /�Q �p /7nGp ADDRESS /��Jl.�\�/�-'7� Ivl V 1 Ir Iv l l�7 1 '1�et CA `� / 5O 4 PHONE (`7� ) iP (/q�-Lf „ �EMAIL rrio 1KSGL I r 9D gn-V,5j - CDWZ CONTRACTOR'S NAME OWNERBUILDER? OYES,<NO BUSINESS NAME MMVJ nd� ion �I ADDRESS / S ( GA --12�j PHONE N � 6P-7q- µ,5n2 EMAIL rylbn kSG1 r Z Gam CONTRACTOR'S STATE LIC NUMBER q I L J9L{ LICENSE CLASSIFICATION CZQ VALUATION$ C? 263 b -0 SO FT 7:1 L SO FT APPLICANT'S SIGNATURE DATE CY---j CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIPINVOICE K AMOUNT 1 1310- PAID AMOUNT lO O CASH O CHECK# O CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT 0CASH 0 CHECK# 0CREDIT CARD VIWNIC 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 E O 0 0 U C? u z 0 '71 E to 'm J216 E c w � v 0 to MM CL r= ty .0 0 E u -J E m =) m m -0 r c E 0 E a ±! -<;�, , ,c c s E4 q 0 = a to I W= z °o.i. 00 m to DO 0 =m E 0 0 0 2 0 Y M 0- 0 r WO 0 E uWO r y Sw LL UO 0 A- w u 0 0 0 m rN Y NN 0 E < un 0 w M u c 0 to 0 0 m w to 0 M C 0 u w .0 C 0 E tu 0 0 x M 0 E 'm a w m u 0 R 0 0 z 0 E 0 a) 0 0 E cc m U, 0 Z U E A r .94 0 w z 0 0 E < N U A Z E m (u w 0 O. > u U a i W ^ Y O O a I N M 3 j i_n a w ry F: o � ry �•' 3 > Non gt V o °c Z N u 6 IL W ❑ W N C m m n l7 V « E N [ p E > a N m v - o °o MJl C � C N O ry o U W v w o a Ln N E rl a° c c v m 3 v u o O V W F} N v w _ ry •N v N Ory p x 7 O O p m p V m y 3 my G p^w mw. _tea Y N Y E Cp a � N C p o S a v v E L c Q V E a o aaj Cl G E I: v a Ll y0 e po m v e FT a u M v' l`4 o N o K �i Y N l T V o o .p O Q e eu E y o m y i 00 L = Lu w C E v 2 o v °1 ry b o o J ei O .a •G 0 00 a v x ;E n •3 •p v 0 E K > w N O n U m u 3 m v v m �� V T in C c W w_ v c E `m Q o _ � Ul u v U O O N U T � o w v a 3 G O m •Y v F- Q v ai u N m ❑ V1 O v E E o v E E o mb o v o M « w co c Yam, m r o Q r N u u o N ry C OD Q = E Q L E w C G m w N � v o w O C V U m 3 a n v c N N n Z E Q ¢ V © ume cU VI U � V U ti w O N in T o v ry 'u uu R N 2 of ~ U •" a v v p c u v m °u O O w W O min Q 1 a u G E E W E W 0 vai e v vutl Eu'1N m Z Z z c O E w x a x u o v E m E m u u N w E a u u u4u w u: w u I O w N m E u ti a °u a m Z' y in N C E v o ry � u° o p E v v o° v m v c a 3 7 E E L oo ° ° U « v d o a v v ° a a ° v m v ¢ I u u v' o O v �'•� 6 � aAl,'. 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