PMT15-02917 l
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City of Menifee Permit No.: PMT16-02917
29714 HAUN RD. g
Wit "' MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 09/21/2015 j
B
:
PERMIT
Site Address: 26073 BLUEBELL ST, MENIFEE, CA Parcel Number: 335-426-014
92586 Construction Cost: $5,790.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, 3.0-TON A/C, 70,000 BTU FURNACE
Work:
Owner Contractor
GAIL CAROLAN MONKS AIR CONDITIONING
26073 BLUEBELL STREET 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 QQb Amount
Air Handling/Condensing Units SFR 1 133.00
GREEN FEE 1 1.00
yGerieraT�Plaft Mamtenfi�tc�e Fed M�chaniba������v��,� 3 "� � - k#� �� �Y�,14 0
$324.10
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
City Of Menifee
i
LInCENSFp DE LA T ❑ I am exempt from Ilcensure under the Contractors'State License Law for tl
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
-'"`---
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence
Expires ff t which I must have resided for aG' least one year prior to completion
( 2.f Improvements covered by this permit,,I cannot legally sell a structure that I hai
Professions Code license is in full once and e
License Class -Q Licens No.
�.7 '�J .� Signatu ,,,,_/____'� built as an owner-bullding If it has not beenconstructed In Its entirety by Ilcenst i
____ Business and Professions Code,is av,
contractors. I understand that a cop of the applicable
WOIjKKRS'COMPENSATION DEGI ARATION ti liable uponn law, Section 7044 of tl
request when this application
submitted or at the following Web slW
❑ 1 hereby affirm under penalty of perjury one of the following declarations: http://www leainfo ca aov/c.; ,aw titre.
I have and will maintain a certificate of consent of sef-Insure for workers'
compensation,Issued by the Director of Industrial Relatipns as provided for by Date
Section 3700 of the Labor Code, for the performance f work for which this
permit is Issued. Property Owner or Authorized Agent',
Policy# ❑ By my Signature below, I certify 0 each of the following; I am the proper ',
1.4 1 have and will maintain workers' compensation Insurance, as required by owner or authorized to act on the property owner's behalf. I have read th
section 3700 of the Labor Code, for the performance of the work for which this application and the Information 1 have provided is correct. I agree to comp
permit Is Issued My workers'compensation Insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to bulldir
construction.I authorize representallyies of this city or county to enter the abov
Carrier t 1 Identified property for the inspection purposes.
Policy# 2=� �, �-j—,_G-W Expires � v®—, Date
Property Owner or Authorized Agent
(This section need not be completed If the permit is for City Business License#
one-hundred dollars($100)or less)
1 certify that in the performance of the work forwhich this permit is Issued,I HAZARDOUS MATERIAL DECLARATION
shall Dot employ any persons In any manner so as to become subject to the Will the applicant or future building Oqccupant handle hazardous material or
workers'compensation laws of California, and agree that if I should become mixture containing a hazardous materisl equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide?
Code,I shall f hwit omply with those provRsions. l DYES %SNO
Appli ant_ �. Date;^_!_ 'I ` ``� Will the intended use of the building by the applicant or future building
T occupant require a permit for the construction or modification from South
WARNING;, FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklis
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES )(NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the cute
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundarx ofaschool?
LABOR CODE, INTEREST,AND ATTORNEYS FEES /
DYESE5,NO
CONSTRUCTION LENDING A E�Y I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of
agency for the performance of the work which this permit Is Issued (Section California Health A Safety.C e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mate Ire orfi .
OWtdER BUILDER DECLARi,�j:[QS ❑YES - NO - pate!
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 chockmark(s)I have placed PRO <04N&94 AUTIIOR17.ED AGENT
next to the applicable items)(Section 7031.5, Business and Professions Code:
Any city or county that requires a permit to construct, alter, Improve, demolish, 9YAk39NOVATION.REPAIF3ANQ PA JMJNG,_(f2�f P�,
or repair any structure, prior to Its Issuance, also requires the applicant for the
permit to file a slgned statement that he or she is licensed pursuant to the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law(Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the-Businpss and.Prgfessions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she Is exempt from.Ilcensure.and the basis for the alleged exemption. Any required practices.This Includes rental property owners and property
violation of Section 7031.5 by any Applicant fora permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit:
❑ I, as owner of theproperty, or m ere to employees with wages as their sole www.epa.gov/lead or contact the National Lead Information Center at
Y P Y 9 1-800-424-LEAD(5323).
compensation, will do( )all of or( )porting of the work,and the structure is
not intended or offered for sale.(Section 7044,Business andProfessions Code;
The Contractor's State License Law does not apply to an owner of a property ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort; builds or Improves the property,
provided that the Improvements are not Intended or offered for sale.If,however, Certified Firm Name:
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 Firm Certification No.:
purpose of sale). ----
❑ I, as owner of the property an exclusively contracting with licensed El No EPA Lead-Safe Certified Firm'Is required for this project because:
contractors to construct the project(Section 7044, Business and Professions —
Code:The Contractor's License Law does not apply td an owner of a property
who builds or Improves thereon, and who contracts for the projects with a ��J` ---'-
• • RMIT/PLAN CHECK APPLICATION
"Menifee
.DATE DATE PERMIT/PLAN CHECK NUMBER S
TYPE: O COMMERCIAL AIESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL,4CMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES JJ��
DESCRIPTION OF WORK - CJ
PROIECTADDRESS LL , 54
i
ASSESSOR'S PARCEL
NUMBER 2 O'v�-k LOT TRACT
OWNER NAME City of Menifeo
pY.
ADDRESS
/� 2/ C / �'/
PHONE("/� Jlp/�-% -{ ) 76 EMAIL
APPLICANT NAME tjot, � ^p,n / Receive
/�enC�`e i V
ADDRESS /��>cl'�l O Mj UMt Iv `lJ I l �et CA '�1 LJO
PHONE (`77! J 4::;7q- SVL„.. EMAILn-j0t1KS0ir9D 1Y1Lljj
CONTRACTOR'S NAME C{GL L\/ 1 V I QCK OWNER BUILDER? O YES I ANO
BUSINESS NAME n
ADDRESS S/ /� v'ZS
//�
PHONE l "!SI) Lp-7q, 4,5002= m ►
n�/' /EMAIL on le-s60 r a7 Gt ta;-L. • GDm
CONTRACTOR'S STATE LIC NUMBER C /Z j—/ G LICENSE CLASSIFICATION CZ
VALUATIONS [J. O U SQ FT L SO FT /
APPLICANTS SIGNATURE DATE — �(�
CITY STAFF USE ONL Y
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PUWNING ENGINEERING FIRE GREEN SMIP X
INVOICE PAID AMOUNT
AMOUNT L9 OCASN OCHEax OCREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O rHECK a O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER 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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