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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. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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