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PMT15-02645 i I City of Menifee Permit No.: PMT16-02646 29714 HAUN RD. m �CF—L!-V " MENIFEE, CA 92586 Type: Residential Mechanical MENIFEE Date Issued: 0 812 712 01 6 i PERMIT Site Address: 26110 ALLENTOWN DR, MENIFEE, CA Parcel Number: 335-273-011 92586 Construction Cost: $6,250.00 Existing Use: Proposed Use: Description of HVAC CHANGE OUT 2.5 TON 5 KW HEAT STRIP Work: Owner Contractor ANTHONY CICERO MONK'S AIR CONDITIONING 26110 ALLENTOWN DR P 0 BOX 128 MENIFEE, CA 92586 SUN CITY, CA 92586 Applicant Phone: 9516794502 GARY MONK License Number: 912194 MONK'S AIR CONDITIONING P0 BOX 128 SUN CITY, CA 92586 - Fee Description Oft 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 building 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 I 1 , City Of Menifee LICENSED DECLAMMON I hereby affirm under penahy or perjury that I am licensed under provisions of ❑ 1, as owner of the property an exclusively contracting with lice i Chapter 9(commencing with sec ton 7000)of Division 3 of the Business and contractors to construct the project(Section 7044. Business and Profess Professions Co my Ilcense is in full rce and eff Code:The Contractor's License Law does not apply to an owner of a pro License Class. License N ( who builds or Improves thereon, and who contrails for the projects w Expire,. -Slgnatu licensed contractor(s)pursuant to the Contractors State Ucense Law). WORKERS'COMPENS'AT)ON DECLARATION ❑ 1 am exempt from Ilcensure under the Contractors'State License Law f ❑ I hereby affirm under penalty of perjury one of the following declarations: following reason: I have and will maintain a certificate of consent of seffansure for workers' By my signature below I acknowledge that,except:for my personal residei compensa)on;issued by the Director of industrial Relations as provided for by which I must have resided .for at least one ,year.'prior to complefi Section 3to'bf the Labor Code,for this Performance of work for which this improvements covered by this palm k I cannot legally sell a s#Wture that I perk Is Issued. bulk as an owner-buiding if it has not been oonsWctsd 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 available upon request when this applics section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:h=1Ay,w iealnf%0.eovlrxafa%html. permit is Issued.My worrkeers'compensation Insurance carrier and policy number are: Carrier , f i6i"—Owner or Fwffion-zR Agent Date Expires Policy# 112- 0/j W 12^ [L Name of Agent Phone# ❑ By my Signature below, I certify to each of the following: I am the pr owner or acdhorized to act on the property awner's behalf. I have roe (This section need Dg),be completed if the perit Is for application and the Info 'on I have provided is corecL I agree to c one-hundred dollars($100)or less) 11denffW ppli ble city unty ordinances and state laws relating to b o resentatives of this city or county to enter the i ❑ 1 certify that in the performance of the work for 01c h this,perlt is issued,I rty in on purposes. shell not am Y any persons In any manner so as to become subject to the workers'compensadon laws of Cal Is,and agree If 1 should become O subject to the workers compensation of n 3700 of the Labor er Arnhbrtrsd t Data Cade,I shall torthwhh comply with those ons. Chy Business License# Date; 0 0 WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIALi3ECLARATION 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,Or-ZOMPENSATION, �S OCCUPANT HANDLE A HAZARDOUS MATERIAL 01 DAMAGES AS PROVIDED FOR IN SIECTiON`3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATER LABOR CODE,INTEREST,AND ATTORNEYS FEES �0 EQUAL TO OR GREATER THAN THE AMOUN QQNSTRUCTION LENDING AGENCY 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 themork 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 MODIFICAM Lender's Address 0 FROM THE SOUTH COAST AIR QUALITY MANAGEMF DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST F OWNER BUILDER DE=RATIONS GUIDE LINES I hereby affirm under penalty J perjury that I am exempt from the Contradices PRINT NAME: License Law for the raesm(s)indicated below by the chadmiark(s)I have placed OYES WILLTHE PROPOSED BUILDING OR MODIFIED FACIL next to the applicable Rem(s)(Sedfon 7031.5.Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY C Any city or county that requires a permit to construct,after,improve, demolish, 0 SCHOOL? or repair any structure, prior to its Issuance,also requires the applicant for the perk to file a signed statement that he or she Is licensed pursuant to the provisions of the Contradves State License Law(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 X9S INFORMATION GUIDE AND THE SCAQMD PERMIT she Is exempt from licensure and the basis Tor the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREME violation of Section 7031.5 by any Applicant for a peimh subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAf a civil penalty of not more than($500).) CODE SECTION 25505 633 AND 25534 CONCERI CI 1, as owner of the property, or my employees with wages as their sole HAL1tfD0US MATERIAL ORl ING. compensation,will do( )all of or( )poring of the work,and the structure Is P W UTHORIZED.AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property T_ who, through employees' or personal effort, builds or improves the property, provided that the Improvements are not intended or offered for sale.If,however, the building or Improvement is sold within one year of completion,the Owner- Builder will have the burden of proving that it was not built or Improved for the purpose of sale). BUILDING : . . . • Menlfee DATE -Z�' ` PERMIT/PLAN CHECK NUMBER i5 'OoZ TYPE: 0 COMMERCIAL AIESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: 0 ADDITION O ALTERATION O DEMOLITION 0 ELECTRICAL->CMECHANICAL O NEW 0 PLUMBING 0 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK J n PROJECTADDRESS 2 6� I l D A' ASSESSOR'S PARCEL NUMBER 01 l LOT TRACT q-1 Of L( t OWNERNAME r, ADDRESS 2 // \ /I !"I iI I f uj Dr . PHONE ���' ) � 'I J p 22 y,n� EMAIL APPLICANT NAME ' tj ADDRESS 3�� �5/ 0 M U rr M en l �eie CA g25N PHONE r// 51) W !/�-Lf 502 EMAII.rno tKSa I Y'eD G n-aI d • cbrn CONTRACTOR'S NAME _/1 q r- ► V I Q� OWNER BUILDER? 0 YESXN0 BUSINESS NAME Cond4ibr) 1'nzq ADDRESS ( GA qZS PHONE C"///�� 5 J5/ / 6r7Q- 4,502. EMAIL mpnV-Salr Z G1"%C -L . GDvrn CONTRACTOR'S STATE LIC NUMBER 6I I L 1914 LICENSE CLASSIFICATION CZQ VALUATION$ 2-S SO FT 20 L SQ FTC APPLICANT'S SIGNATURE CITYSTAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE I I PAID AMOUNT AMOUNT D 0CASH 0 CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT O CASH O CHECK a O CREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER 0 YES O NO City of Menifee Building&Safety Department 29714 Haun Rd. 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