PMT15-03815 City of Menifee Permit No.: PMT15-03815
29714 HAUN RD. T Residential Mechanical
�I-►CCELA— MENIFEE, CA 92586 yam'
MENIFEE Date Issued:
12/11/2015
PERMIT
Site Address: 26150 ALBANY DR, MENIFEE, CA 92586 Parcel Number: 335-262-007
Construction Cost: $6,650.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, 2.5-TON OVER UNDER PUMP,30,000 BTU
Work:
Owner Contractor
GRANT STIPE MONKS AIR CONDITIONING
31951 GOLDEN WILLOW COURT P 0 BOX 128
WI NCH ESTER, CA 92586 SUN CITY, CA 92586
Applicant Phone: 9516794502
TIFFANI SELLERS License Number:912194
MONKS AIR CONDITIONING
PO BOX128
SUN CITY, CA 92586
Fee Description Qtv Amount 151
Forced-Air or Gravity-Type Furnace or Bumer 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
specications 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_Templale.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from licensure under the Contractors'State License Law for it
I hereby aRrm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing with section 700D)of Division 3 of the Business and By my signature below I acknowledge that,except for my personal residence
Professions Code license Is in full force and efi t which I must have resided for at least one year prior to completion
License Class _Licens No. 2� improvements covered by this permit. I cannot legally sell a structure that I he,
Expires 3-31- I(o Signatu built as an owner-bullding if It.has not been constructed In its entirety by[loans(
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 of perjury one of the following declarations: htto://www.leninfo.p.00v/plaw.html.
1 have and will maintain a certificate of consent 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
$( I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read Ih
section 3700 of the Labor Code, for the performance of 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 carrier and pollcy number are: with all applicable city and county ordinances and state laws relating to bui[dir
C� , construction.I authorize representatives of this city or county to enter the abov
Carrier c. Identified property for the Inspection purposes.
I — ' — I(�Policy#_I 2.760- �j�Expires Property Owner or Authorized Agent Date
(This section need Asl be completed If the permit is for City Business License#
one-hundred dollars($100)or less)
I certify that In the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ 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 s ecifined on the Hazardous Materials Information Guide?
Code,I shall f 9Phwi mply with those provisions. ❑YES NO
Appli nt Date; I —q— 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(SCAOMD)?See permitting checklis
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OYES �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 outs
DAMAGES AS PROVIDED FOR IIN SECTION 3706 OF THE bounda ofa school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES OYES NO
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.C e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mateififil re ortmA.
OWNER BUILDER DECLARATIONS ❑YES NO ^ n'
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Dale L (•�
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROk-R-T<04NAa9K 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, alter, Improve, demolish, EPA RENOVATION,REPAIR AND PAINTING(RRPI
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 Slate License Law(Chapter 9 (commencing with receiving compensation for most work that disturbs paint in apre-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.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 peril 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.govllead 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 O An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort: builds or improves the properly,
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 O 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 PERMIT/.PERMIT/PLAN CHECK APPLICATION
Wenifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL AtESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL��eKMECHANICA6jty of Menfee
O NEW\ I O PPLUMBING O RE-ROOF-NUMBER OF SQUARES Idin DPI
DESCRIPTION OF WORK V rl w 2 , 5 n r 15
l U l -I /, r� 3c) K 9TU
IV
PROJECT ADDRESS 2 Co 1 I bi z I Dr • I e
ASSESSOR'S PARCEL NUMBER 33S�02 00 LOT I\ rY TRACT °I
OWNER NAME (- S+
ADDRESS PHONE (37 610/)SM < i✓lUyO� EMWAIL 11 9 252 6
APPLICANTNAME a r (Dy Y ADDRESS 3c01 /5 )O MU rr M�YI �'ee ca g25S
PHONE (q51) (P ! 7�-Lf 502 EMAILrrionK50 I r eD 0/YIQ;d • Cbrn
/
CONTRACTOR'S NAME 1.1 O,!�l I V I Q(LK ,,JJ OWNER BUILDER? O YES NO
BUSINESS NAME _ J nd bn t
ADDRESS /� 5 ( GA `!25
PHONE (g5lf EMAIL rY)on 4S60r Z C.a m
CONTRACTOR'S STATE�LICC�NUMBER `mi nl /Z 1/]Lj LICENSE CLASSIFICATION CZQ
VALUATION$ ICJ J , SO FT 13 Z Y L SQ FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ` SMIP
INVOICE PAID AMOUNT
AMOUNT IO 0C H 0 CHECK# OCREDITCARD VISA/MC
PLAN CHECK FE.ES PAID AMOUNT 0CASH 0 CHECK# OCREDITCARD VISAIMC
OWNER BUILDER VERIFIED O YES 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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