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PMT16-01474 City of Menifee Permit No.: PMT16-01474 _ 29714 HAUN RD. Type: Residential Mechanical <A—CCEL/ie�.' MENIFEE, CA 92586 MENIFEE Date Issued: g5111/2016 PERMIT Site Address: 27532 PINCKNEY WAY, MENIFEE, CA Parcel Number: 336-354-003 92586 Construction Cost: $4,925.00 Existing Use: Proposed Use: Description of HVAC CHANGE OUT 3.0 TON, 14 SEER A/C,70,000 BTU FURNACE Work: Owner Contractor BILL MCINTOSH MONK'S AIR CONDITIONING 27532 PINCKNEY WAY P O BOX 128 MENIFEE, CA 92586 SUN CITY,CA 92586 Applicant Phone:9516794502 GARY MONK License Number:912194 MONK'S AIR CONDITIONING P0 BOX 128 SUN CITY, CA 92586 Fee Description O0rt Amount fSl 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 specifications or from preventing building 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_BIdg_Pernit_Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exemptfrom lkensure under the Contractor's State License Law for Professions Code and my license is in full force and effect. the following reason: License Class License No. By my signature below I acknowledge that,except for my personal residence Expires Signature in which I must have resided for at least one year prior to completion of improvements covered by this permit.I cannot legally sell a structure that I WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by ❑1 hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Code,is available upon request when compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website: by Section 3700 of the Labor Code,for the performance of work for which ,,t„wwleginfo.ca.gov/calaw.htmi. this permit is issued. Policy# Date PROPERTY OWNER OR AUTHORIZED AGENT ❑I have and will maintain workers compensation insurance,as required by section 3700 of the tabor Code,for the performance of the work for which ❑By my signature below 1 certify to each of the following:I am the property this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this number are: application and the information I have provided is correct.I agree to comply Carrier with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy# Expires enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred Date dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT ❑I certify that in the performance of the work for which this permit is issued, 1 shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant Date mixture containing a hazardous material equal to orgreater thatt'e amounts specified on the Hazardous Materials Information Guide. WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY D Yes ❑No I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the lending agency for the performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) ❑Yes ❑No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of Contractors License Law for the reason(s)indicated below by the California Health al Safety Code,Section 25505 and 25534 concerning hazardous material reporting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 DYes ❑Na Business and Professions Code).Any city or county that requires a permit to Date construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT issuance,also requires the applicant forthe permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRP) License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors Business and Professions Code)orthat he orshe is exempt from Iicensure receiving compensation for most work that disturbs paint in a pre-1978 and the basis forthe alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property than($500). managers who do the paint-disturbing work themselves or through their ❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit: compensation,will do( )all of or( )portion of the work,and the structure is www.epa.eov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323). Code;The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project property who,through employees'or personal effort,builds or improves the property provided that the improvements are not intended or offered for Certified Firm Name: sale.If,however,the building or improvement is sold within one year of Firm Certification No.: completion,the Owner-Builder will have the burden of proving that it was not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required forthis project because: ❑I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement. APPLICATIONBUILDING SAFETY PERMIT/PLAN CHECK Menifee DATE PERMIT/PLAN CHECK NUMBER II TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL MECHANICAL OINEE'W O PLUMBING C RE-ROOF-NUMBER OF SQUARES �- DESCRIPTION OF WORK iTVAC� ` Q( U �• n PROJECIJ, DRE": ASSESSOR'S PARCEL NUMBER pp 33� 3�-� �y LOT Z 3 TRACT Z 30�1 OWNER NAME J , I ��IC C ADDRESS L /�J g PHONE / _i2 (/ y� EMAIL � APPLICANT NNA/MMEGL r 1 `.u ADDRESS /J�cV' J/��70/] �1M 0 -* � � �' CA C125R PHONE (`7J� ) �P `/I- 502 EMAIL 0Y CONTRACTOR'S NAME l�l �-� I �/I O' S��.�"w OWNER BUILDER? YEESS NO BUSINESS NAME / I Y l..l.)nU I bYl I ADDRESS//� lS I �25 PHONE l "/S' 1 67 JC n,2 �7/EMAIL mOnI-SG.•Ir a7 ►'n l- • Cam CONTRACTOR'S STATE LIC NUMBER `�/f 2 I_/n` LICENSE CLASSIFICATION C2-0 VALUATION$ 25 SQ FT \ -SU L SO FT APPLICANT'S SIGNATURE DATE CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CRY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE �I PAID AMOUNT O CREOIT CARD VISA/MC AMOUNT il• OCASH OCHECK# PLAN CHECK FEES PAID AMOUNT 0 CASH O CHECK# O CREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&SPfety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.city finenifee.us Inspection Request Line 951-246-6213 City Of Menifee LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'Stale License Law forth I hereby affirm under penalty or perjury that I am licens 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 eff L which I must have resided for at least one year prior to completion c License Class Ucens No. ZL improvements covered by this permit.I cannot legally sell a structure that I have Expires Signatu built as an owner-building if it has not been constructed in its entirety by licensee contractors. I understand that a copy of the applicable law, Section 7044 of the WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application is submitted or at the following Web she: ❑ 1 hereby affirm under penalty of perjury one of the allowing declarations: htto:lhvwwlecinfo.ca cov%ralaw.html. I have and will maintain a certificate of consent of s If-insure for workers' compensation,issued by the Director of Industrial Relate ns as provided for by Dale Section 3700 of the Labor Code, for the performance f work for which this permit is issued. Property Owner orAuthonked Agent ,Policy# ❑ By my Signature below, I certify to each of the following: I am the propery n� I have and will maintain workers' compensation ins mince, as required by owner or authorized to act on the property owner's behalf. I have read the: section 3700 of the Labor Code, for the performance of a work for which this application and the information I have provided is correct I agree to comply permit is issued.My workers'compensation insurance came and policy number are: with all applicable city andicounty ordinances and state laws relating to buildinc C i^ 1 construction.I authorize representatives of this city or county to enter the above. Cartier c.�7���7 ) identified property for the inspection purposes. Policy#� L-' /��� /Z Expires �— — / Date Property Owner or Authorized Agent (This section need not be completed if the permit is for CI Business License# /r'''� 2� - 7 one-hundred dollars($100)or less) City l HAZARDOUS MATERIAL DECLARATION I certify that in the performance of the work for which is permit Is issued,I shall not emmlov any persons in any manner so as to ecome subject to the Will the applicant or futurejbuilding occupant handle hazardous material or a 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 ecified on the Hazardous Materials Information Guide? Code,I shall f hwi reply with those provisions. DYES WIND I AppleDate;ant• 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 SUBJECT AN EMPLOYER TU CRIMINAL PENALTIES AND DYES KI CIVIL FINES UP TO ONE HUNDRED THOUOAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounds ofa school? LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES boundary 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 Safety Cppgm[[�(e,Section 25505 and 25534 concerning 3097 Civil Code) hazardous mate Ire morn;A./ OWNER BUILDER DECLARATIONS DYES NO I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date License Law for the reasons)indicated below by the checkmark(s)I have placed PROk-RT<0dNi AUTHORIZED AGENT next to the applicable tterri(Section 7031.5. Business acid Professions Code: , Any ciy 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 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 Contractors State License Law(Chapterig (commencing with receiving compensation for most work that disturbs paint In a pre-1978 Section 7000)of Division 3 of the Business and Profession's Code)or that he or residence or childcare facility to be RRP-certified firms and comply with she is exempt from licansure 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 information about EPA's Renovation Program visit: wwwepa.govAead 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,land the structure is not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's Stale License Law dons not apply to an owner of a property ❑An EPA Lead-Safe Cerif.ad 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 improved for the Firm Certification 1 o.: purpose of sale). N ❑ 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(S"_ on 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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