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PMT15-03210 City of Menifee Permit No.: PMT15-03210 29714 HAUN RD. <ACCELA.. MENIFEE, CA 92586 Type: Residential Mechanical MENIFEE Date Issued: 1 0/1 612 01 5 PERMIT Site Address: 26071 BRANDYWINE DR, MENIFEE,CA Parcel Number: 335-143-002 92586 Construction Cost: $7,285.00 Existing Use: Proposed Use: Description of HVAC CHANGE OUT, 3.0-TON OVER/UNDER HEAT PUMP Work: Owner Contractor CHARLOTTE ECCLES-LUMPKIN MONK'S AIR CONDITIONING 26071 BRANDYWINE DRIVE P O BOX 128 MENIFEE, CA 92586 SUN CITY, CA 92586 Applicant Phone:9516794502 TIFFANI SELLERS License Number:912194 MONK'S AIR CONDITIONING PO BOX128 SUN CITY, CA 92586 Fee Description Oft Amount($1 Forced-Air or Gravity-Type Furnace or Burner 1 149.00 Air Handling/Condensing Units SFR 1 133.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Mechanical 1 14.10 $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 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 ❑ 1 am exempt from licensure under the Contractors'State License Law fort 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 Professions Code and��^license is in full force and eff= t which I must have resided for at least one year prior to completion License 2Class- No. 2� improvements covered by this permit, I cannot legally sell a structure that I he, F�tpiresJ-31- Ito SignatuLicens built as an owner-building If It has not been constructed in its entirety by Ilcenst contractors. I understand that a copy of the applicable law, Section 7044 of 0 WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application submitted or at the following Web site: ❑ I hereby affirm under penalty i perjury one the following declarations: http:/A�feciinfo.ca.gov/calaw.html feciinfo.ca.gov/calaw.html. I have and will maintain a certificate of consentt of self-Insure for workers' compensation,issued by the Director of Industrial Relations as provided for by Date Section 3700 of the Labor Code,for the performance of work for which this permit is Issued. Property Owner or Authorized Agent Policy# ❑ By my Signature below, I certify to each of the following: I am the proper V_ I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owners 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 buildir CC� rr� construction.I authorize representatives of this city or county to enter the abov Carrier I r identified property for the inspection purposes. Policy#I G I 2— Expires �— I — I(O 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) y I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION shall not emolov any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or. workers'compensation laws of California, and agree that If I should become mixture containing a hazardous material equal to or greater that the subject to the workers'compensation provisions of Section 3700 of the Labor amounts ecified on the Hazardous Materials Information Guide? Code,I shall f hwit mply with those provLglnn= OYES 'ZNO Appli an ,Date; I 1 J�-I� I WIII the intended use of the building by the applicant or future building 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 XNO 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 oute DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounda ofaschool? LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑YES VNO CONSTRUCTION LENDING AGENCY 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 Cgle,Section 25505 and 25534 concerning 3097 Civil Code) hazardous mate 1 re orti OWNER BUILDER DECLARATIONS ❑YES NO Date I Vr �✓�IS 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 checkmark(s)I have placed PRO CiAhP4 AUTHORIZED AGENT next to the applicable item(s)(Section 7031.5. Business and Professions Code: Any city or county that requires a permit to construct, after, improve, demolish, EPA RENOVATION,REPAIR AND PAINTING(RRP) 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 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-Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with she is exempt from.licensure 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: www.epa.govnead or contact the National Lead Information Center at ❑ I, as owner of the property, or my employees with wages as their sole 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 and Professions 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 purpose of sale). Firm Certification No.: ❑ I, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Finn 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 BUILDING & SAFETY • •LAN CHECK-APPLICATION "Menifee DATE 1 - PERMIT/PLAN CHECK NUMBER 5 - c a io TYPE: O COMMERCIAL .)rkESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOUSPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL�>KMECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK (J I•� X r PROJECTADDRESS 2-(�;071 r 61-L Dr. . Lu,\ cLl tj: '9z5 ASSESSOR'S PARCEL NUMBER 335- 143-Do 2 LOT -41 TRACT 3 O 3 J OWNER NAM _.(E aa- -C, Eccles - Uo, -M ADDRESS n2 0 /I .ro nC e-, C -I ZrJ2- PHONE 1EMAIL APPLICANT NAME r ►,� j:/ ADDRESS //30530 M u rr Mtr ( f-e-e CA CI 594 PHONE (7JI �P !���) SOIL EMAIL rrionKSOIY'tD 0 0-kgj . Corn CONTRACTOR'S NAME OWNER BUILDER? O YESX NO � BUSINESSNAME — ( ndi 4ibra ADDRESS 5 PHONE I�j'4(EMAIL m 'I an►csar a-.) m CZ a;-L - rn n CONTRACTOR'S STATE LIC NUMBER ` ?12-l(` LICENSE CLASSIFICATION CZQ VALUATION$ 2 ES nO SO FT1,3 ? L SQ FT APPUCANT'SSIGNATURE .IC/ `'�'� rr� DATE CITYSTAFF.USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGwEERMG FIRE GREEN !' SMIP X INVOICE PAID AMOUNT AMOUNT O CASH 0 CHECK# O CREDIT CARD V WMC PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# OCREDITCABD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. 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