PMT15-02546 I
City of Menifee Permit No.: PMT16-02546
29714 HAUN RD,
/ MENIFEE, CA 92586 Type: Residential Mechanical
6m 'm+s Sdlxsp
MENIFEE Date Issued: 08/20/2015 1
I
1
PERMIT
Site Address: 27226 CAPILANO DR, MENIFEE, CA Parcel Number: 336-062-020
92586 Construction Cost: $5,870.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT 3-TON A/C, 70,000 BTU FURNACE
Work:
Owner Contractor
FRANCES RUMA MONK'S AIR CONDITIONING
2859 TERRY ROAD P 0 BOX 128
LAGUNA BEACH, CA 92651 SUN CITY, CA 92586
Applicant Phone: 9516794502
TIFFANI SELLERS License Number: 912194
MONK'S AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description Qtty Amount ISI -
F
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_Templatexpt Page 1 of 1
i
City Of Menifee
LICENSED DECLARATION
I hereby a(finn undo,r malty,or perjury that I am licensed under provisions of ❑ 1, 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
Professions C my Ilcense Is In full roe and effe Code:The Contractor's License Law does not apply to an owner of a pro
License�Qla2sst. '._,.. License N j who builds or Improves thereon, and who contracts for the projects x
Expfre: .GL1� 'Signatu licensed contactor(s)pursuant to the Contractors State License Law)
WORKERS'COMPENSATION DECLARATION ❑ I am exempt from Ilcensure under the Contractors'State License Law fi
❑ 1 hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of aft sure for workers' By my signature below I acknowledge that,except,for my personal resides
compensagon,Issued by the Director of Industrial Relations as provided for by which I must have resided .for at least one year. prior to compleb
Section 37t)D.of the Labor,Code,for the performance of work fbr which this Improvements coveted by th s perm t I can110t,1egally sell a structure that I
permit is Issued• bulk as an owneo-butiding if it has not been constructed in its entirety by sic
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 available upon request when this applica
section 3700 of the Labor Code, for the perfomrence of the work for which this submitted or at t he foltowing Web s te:h�Mnww.leelnto ce eovlceiaw html.
permit is Issued.My workers'compensation insurance carrier and pot*number are:
f^! - roper4y owner or or¢ . en - D
Caner J"
Expires — Policy#��� w I G' L. ..
Phone# ❑ By m Signature below, I certify to each of the following: I am the pr
Name ofA gent
owner or
acdhorizad to act on the property owner's behalf. 1'have rarer
(This section need IJ9$be completed If the permit is for application and the Info 1 have provided is correct. I agree to c
one-hundred dollars($100)or less) with all applicable dry ur ty ordinances and state laws relating to b
constructio resentatives of this city or county to enter the c
❑ I certify that in the.performance of the work for which this.permit is Issued,I identified rty 9 in edfon purposes.
shall netnot amclov any persons In any manner so as to become subject to the
workers'compensation laws of California,and agree th If I should become
subject to the workers compensation of n 3700 of the Labor. P , nor Authorhmd Agent Date
Code,I shall forthwith comply with those p ons.
City Business License#
Date; Appbi
WARNING: FAILURE TO - SECURE WORKERS' IAL 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 BUILDII
($100,000),IN ADDITION TO THE COST OF.COMPENSATION, ❑YES OCCUPANT HANDLE A HAZARDOUS MATERIAL OI
DAMAGES AS PROVIDED FOR IN SECTIIOtjl`3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERI
LABOR CODE,INTEREST,AND ATTORNEYS PEES >O EQUAL TO OR GREATER THAN THE AMOUN
r_QNMUCTIONLENDIN6AGENCY SPECIFIED ON .THE HAZARDOUS MATERIA
I hereby affirm that under the penalty of perjury there is a construction lending INFORMATION GUIDE?
307 agency for
Code) APPLICANT of the work which this permit is issued(Section WILL THE INTENDED USE OF THE BUILDING BY 1
APPLICANT OR FUTURE BUILDING OCCUPANT REQU
Lender's Nam® DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICAT
Lender's Address �rea'�",J FROM THE SOUTH COAST AIR QUALITY MANAGEME
DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST F
GUIDE LINES
OWNER BUILDER DELI ARATIONS
I hereby affirm under penalty,of perjury that I am exempt from the Contractor's PRINT NAME: -
Licanse Law for the reason(s)Indicated below by the chedonark(s)I have placed []YES WILL THE PROPOSED BUILDING OR MODIFIED FACIL
next to the applicable ftem(s)(Section 7031.5.Business and Professions Carle: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY 0
Any city or county that requires a permit to construct,alter, Improve,demolish, �O 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
provisions of the Contractors State Ucense Law(Chapter 9(commencing with 1 HAVE READ THE HAZARDOUS MATEF
Section 7000)of Division 3 of the Business and Profession Cade)or that he or >ZtS INFORMATION GUIDE AND THE SCAQMD PERMIT
she Is exempt from Ixensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREME
violation of Section 7031.5 by any Applicant for a peimft subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAI
a olvfl penalty of not more than($500).) CODE SECTION 25505 33 AND 25534 CONCERT
❑ I, as owner of the property, or my employees with wages as their sole HA7AI�DOUS MATERIAL Of7tING.
compensation,will do( )all of or( )porting of the work,and the structure is P W UTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's We ticense Law does not apply to an owner of a properly . .
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not Intended or of Brad for sale.If,however,
the building or improverrent is sold wNhin one year of completion,the Owner.
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
& SAFETY • IT/PLANAPPLICATION.
r ,,Iding R< Safety Dep .
�kMenifee AUG 2 0 2015
DATE � �= PERMIT/PLAN CHECK NUMBER5
TYPE: O COMMERCIAL .'RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOVSPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 5.
TJ k_ 3T-0 �r// C' C � /1
PROJECTADDRESS / ZZ(Q Ll -�� l C� 11 s0n C_j,& �l/�
ASSESSOR'S PARCELL NUMBER 33 � CX 2- O -U LOT 5 l TRACT `� 0 Z
OWNER NAME Fr_ C Pad ,
j I
ADDRESS � O/1J/��/ Te_rr Pad ec? CA /�LLno `( z�,S
PHONE C`( 7�7 J (//�`7 l�!C Z ��EMAIL
APPLICANTNAME u r jy� k,
ADDRESS /3�c01\5:3)QM Q��r-f M fr- ( ate CA CI 5F
PHONE rq5 J IP l/�-.-7 5m A EMAIL►n0nK50l1� rywCd , cbrn
C NTRACTOWS NAME l.► A I� ' vl Q(/`� OWNER BUILDER? O YESXNO
BUSINESS NAME c MMVI� I L._u►' dI on I
ADDRESS /� 1J ( CI25
PHONE (qSI 1 EMAIL mbnkSGilr Z ry,6 -L . Gcm
CONTRACTOR'S STATE LIC NUMBER CI IZ RZ4 LICENSE CLASSIFICATION C20
VALUATION$ r SO FT i O Z L SO FT
APPLICANT'S SIGNATURE DATE S I � �
ONLY .CITY STAFF USE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP X
INVOICE I
PAID AMOUNT
AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDANIOUNT 0CASH OCHECK# 0CREDIT 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 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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