PMT15-03600 City of Menifee Permit No.: PMT15-03600
29714 HAUN RD.\CCELA. MENIFEE,CA 92586 Type: Residential Mechanical
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MENIFEE Date Issued:
11/1712015
PERMIT
Site Address: 28278 ENCANTO DR, MENIFEE, CA Parcel Number: 336-211-007
92586 Construction Cost: $5,075.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT,2.5-TON A/C, 70,000 BTU FURNACE
Work:
Owner Contractor
LARRY JACOBS MONKS AIR CONDITIONING
28278 ENCANTO DRIVE P O 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 Descrlotlon ,Qty Amount ISI
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_Pernit Template.rpt Page 1 of 1
City Of Menifee.
" LICENSED DECLARATION 13.I am exempt from licensure underthe Contractors;State Ucense'Law for,'tt
following reason: '
"I hereby affirm under penalty or perjury that I am licensed under provisions of
Chapter.9(commencing with section 7000)of Division 3 of the Business and.' " Bp'my signetdre'below( acknowledge that,except for my personal tesTdence
..Professions Code-an(t Ilcense 15 in full force and eff= t.- "'which I must have resided for at least one year .prior to completion
License Class (1i,1 Ucens No. . Z improvements covered by this.permit"I"rannol legally sell a structure that I ba+
"Expires ^3 t to Signatu - built as.an.owner-b Wding If it has not been constructed In its entirety by licensr
_ contractors. i understand that a copy of the applicable.law,Section 7044 of it
i
` " ' " Business and Professions Cade,is available upon request when this application
".WORKERS'COMRENSATION DECLARATION" submitted or at the following Web site:
0. 1 hereby affirm under penalty of"perjury one of"the following declarations: htLQY/wvnv leainfoce eau/calaw html:
I have and will maintain.a certificate of consent of self-insure for workers' ..
compensation,issued by the Director of Industrial Relations as provided forb - "
P Y
Section 3700 of the Labor Code,for the performance of work for which this -
": "permit is issued, . Property.Owner orAuthorizedA gent ..
. Policy# - ❑ By my Signature below, I cart fyto each of the followbr9: 1 am the proper
. ".� 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
I"hve-ad
." section" the Labor Code, for the performance n the work for which this"..., application and the information I have provided is correct I agree to comp
- permit is Issued.My workers'compensation insurance carder and policy number.are:�. with all applicable city and county ordinances and slate laws relating to bulldir
I authorize o rco en bov
�'�• construction. a prize i s tyo un o r ea
identified property for the inspection purposes..
Policy#f/Z' 700" I Z ExPires —`� I Date
Property Owner orAuthodzed Agent
-""o(This section need not be completed If the permit is for. - ' '
hundreddollars($100).or less). es _City Bus'in s License .
. HAZARDOUS MATERIAL DECLARATION
4.cettifythatintheperforhianceof the vi(iikforwhich this permit Is issued,I
shall not emolov any Persons in any manner so as to became subject to the Will the applicant or futurebuilding occupant handle hazardous material or:
workers'compensation laws of California,and agree that if 1 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 specified on the Hazardous Materials Information Guide?
Code,I shall hwit mply with those pro1vtain^= /r1 - `AYES X NO "
�Applf an• Date;_( ' —( 1�� Will the intended.uset of the building by the applicant of future"bu9ding .
..occupant require a permit for the construction or modificallon from South..
WARNING: - FAILURE TO SECURE WORKERS' .. Coast Air Quality Management District(SCAQMD)?See permitting checklL
COMPENSATION COVERAGE IS. UNLAWFUL, AND SHALL for guidelines - -
SUBJECT AR EMPLOYER TO CRIMINAL PENALTIES AND DYES )(NO -
-' CIVIL FINES UP.TO ONE HUNDRED THOUSAND DOLLARS Will theproposedbuildingormodlfedfaclhtytiewithin1000feetoftheouG
($100,0.00),IN ADDITION TO THE COST OF COMPENSATION
DAMAGES AS PROVIDED.FOR 1N SECTION 3706 OF THE " bounds ofaschooi? ..
LABOR CQDE,.INTEREST,AND ATTORNEYS FEES OYES XO
. CONSTRUCTION LENDING AGENCY. "
" -. 1 have read the Hazardous Material information Guide err the tale of
I hereby affirm that under the penalty of perjury there is a construction lending " permitting checklist,I understand my requirements under State of
agency for the performance.of the work which this permit Is issued(Section .. California Health Safety C "e,Section 25505 and 25534 concemf.9
-3097 Civil Cade) .. .. hazardous mate Ire orti /f -
OWNER"BUILDER DECLARATIONS OYES. NO Date
t hereby affirm under Penalty of perjury that I am exempt from the Contractors
License Law for the reasons)indicated below by the checkmalk(s)I have placed PRO O N . AUTHORIZED AGENT' -
-"next to the applicable ftem(s)(Section 7031.5.Business and Professions.Code::" EPA RENOVATION:REPAIR AND PAINTING{RRP)'" .. '.
.. Any oily or county that requires a permit to.construcl, alter,improve,demolish;
or repair any structure,prior'to its issuance,also requires the applicant for the. "
permit to file a signed statement Ihat 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 Professions Code)or that he or' residence or childcare facility to be RRP-certified firms and comply with.
she is exempt from Acensure_and the basis for the alleged.exemption.Any 'required practices.This includes rental property owners and property .
violation of Section 703:1.5 by any Applipant 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.gov/lead or contact the National Lead Information Center at ..,.
. O 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 sWcture is
not intended or offered for sale,(Section 7044,Business and Professions Code;.
-The Qontractor's State License.Law does riot apply to an owner of a property,""_ D'Ad EPA.Lead-Safe Certified Renovator'wili be responsible.forthis'project
who, through employees' or,personal effort; builds or improves.the property, . ..
-provided that the improvements are not intended of offered for sale.If,however, ..'" " -
:- the"building or improvement is sold within one year of completion,the Owner- .. Certified Frm Name:
- "Binder will have the burden of proving that it was not built or improved for the " "
... purpose of sale).
. . n No..'. "'" Finn "
" O No EPA•Lead-Safe Certified Flmi is requiredfor this project"because:
"
I;. as owner "of the-properly an exclusively'contracting"with -
contractors to construct the project.(Section 7044..Business and Professions' -
...Code:The Centractor't License Law does notapplytdan owner ofa property, - "
who builds or improves thereon, and who contracts for the projects-with a -"
irrpn=Pd rnntmrinri�i nnrsnant to iha CnntrarJnm RtalP I ir.Pnn.i awl -If vpurrimlart dnPc not mmhly with FPA RRPndp tilaaxA fill Qpt the RRP'"
BUILDING & SAF ETY PERMIT/PLAN CHECK APPLICATION
Adft�'Wenifee
DATE PERMIT/PLAN CHECK NUMBER O LOOO
TYPE: O COMMERCIAL b RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOUTION O ELECTRICAL_--V-,MECHANICAL
O NEW` ` O PLUMBING O RE-ROOF-NUMBER OF SQUARES --
11 G
DESCRIPTION OF WORK � c '
-70 C
PROJECTADDRESS 2S Z jE/'1 �• M�� � e � �
ASSESSOR'S PARCEL NUMBER O ' 3 LOT �7 _ TRACT
OWNER NAME �r a
ADDRESS
/'2 7�
PHONE (�jJ� NI ' D J�/ y� EMAIL
APPLICANT NAME
ADDRESS 3�53-onM CM5R4
PHONE (`�� /
) IP !/%�--1r502 �EEMAII-Irno '1KSa I v-9D ►na j • CDYYL
CONTRACTOR'S NAME U a 1 Y I yl Q lt`� ,r( OWNER BUILDER? OYES O
BUSINESS NAME l�l)11UI �bYll
ADDRESS n S CA
PHONE �qSl G�� EMAIL mon ksa.'I r aD 9 rnaU . C.Drrm
CONTRACTOR'S STATE LIC NUMBER 912 l+/]L/ LICENSE CLASSIFICATION C2_0
VALUATION 5-, 1 SOFT /Oz LSO FT /
APPLICANT'S SIGNATURE ^` DATECITY STAFF USE ONL�-
_LS
DEPARTMEM DISTRIBUTION CITY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING .FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT In I
IC7 OCASH O CHECK R OCREDRCARD MSNMC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VIWMC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER 0 YES 0 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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