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PMT16-01308 City of Menifee Permit No.: PMT16-01308 _ 29714 HAUN RD. �CCEL/J. MENIFEE, CA 92586 Type: Residential Mechanical MENIFEE Date Issued: 04/26/2016 PERMIT Site Address: 29578 MOUNT BACHELOR WAY, Parcel Number: 338-252-012 MENIFEE, CA 92586 Construction Cost: $6,300.00 Existing Use: Proposed Use: Description of HVAC CHANGE OUT 3.0 TON 14 SEER A/C,70K BTU FURNACE Work: Owner Contractor LUPE LUNA MONICS AIR CONDITIONING 29578 MOUNT BACHELOR WAY P 0 BOX 128 MENIFEE, CA 92586 SUN CITY, CA 92586 Applicant Phone: 9516794502 GARY MONK License Number:912194 MONKS AIR CONDITIONING PO BOX128 SUN CITY, CA 92586 Fee Description City Amount f51 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_Permil_Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'State License Law forth, hereby affirm under penalty or perjury that I am livens d 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 h Professions Code license is in full force and e t which 1 must have resided for at least one year prior to completion a License Class Livens No. Z� improvements covered by this permit,I cannot legally sell a structure that I haw Expires3-31_ 1_c� Signatu built as an owner-building V it has not been constructed in its entirety by licenser contractors. I understand that a copy of the applicable law,Section 7044 of IN WORKERS'COMPENSATION DECLARATION Business and Professions Cade,is available upon request when this application is submitted or at the followinb Web site: ❑ I hereby affirm under penalty of perjury one of the i allowing declarations: hfio://www.leeinfo.ca.aov%alaw.html. I have and will maintain a certificate of consent of sell-Insure for workers' compensation,issued by the Director of Industrial Retail ns 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 to each of the following: I am the property 15( 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 thi; section 3700 of the Labor Code, for the performance of he work for which this application and the information I have provided is correct I agree to compl) permit is issued.My workers'compensation insurance cardei and policy number are: with all applicable city and!ceunly ordinances and state laws relating to building t construction.I authorize representatives of this city or county to enter the above. Carder F, identified properly for the I spection purposes. Policy# Expires Date Property Owner or Authorized Agent (This section need not be completed it the permit is for h' CI Business License# ! Cl�� one-hundred dollars($100)or less) 1 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 futureibuilding occupant handle hazardous material or a workers'compensation laws of Calgomia,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 Rallied on the Hazardous Materials Information Guide? Code,1 shall f hwi mply with those provisions. I ❑YES ` NU /i Appli nt' Date; — l (J Will 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 Distridt(SCAQMD)?See permitting checklist COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines I SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES XNO CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Nil the proposed building or modified facility be within 1000 feet of the outer DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounds ofaschool? LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES CONSTRUCTION CONSTRUCTION LENDING AGENCY I have read the HazardousMaterial Information Guide and the SCAQMD I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of agency for the performance of the work which this permit is Issued (Section California Health$ Safety Cprle,Section 25505 and 25534 concerning 3097 Civil Code) I hazardous mate}l( I re orti'(/ OWNER BUILDER DECLARATIONS i ❑YES NO` C — 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 PR4ER` OAAEP14 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(RRP) or repair any structure, prior to its issuance, also requiresithe applicant for the permit to rile 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 Contractors State License Law(Chapleri9 (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 fines 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 for a 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 Infommalon about EPNs Renovation Program visit: ❑ I, as owner of the property, or my employees with wages as their sole �.epa.gov/lead or contact the National Lead Information Center at 1-800-424-LEAD(5323). compensation,will do( )all of or( )porting of the work'Jand 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 iowner 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 o�improved for the Firm Certificallon No.: purpose of sale). ❑ I, as owner of the property an exclusively contrasting with licensed 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 to`an owner of a property who builds or Improves thereon, and who contracts for the projects with a licensed contractor(s)pursuant to the Contractors State License Law). 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