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PMT16-01628 City of Menifee Permit No.: PMT16-01628 29714 HAUN RD. Type: Residential Mechanical �ACCEI/!V? MENIFEE, CA 92586 MENIFEE Date Issued: 05/25/2016 PERMIT Site Address: 27166 TERRYTOWN ST, MENIFEE, CA Parcel Number: 336-191-018 92586 Construction Cost: $5,240.00 Existing Use: Proposed Use: Description of HVAC CHANGE OUT 3.0 TON 14 SEER, SINGLE STAGE AC,70K BTU FURNACE Work: Owner Contractor JARED MCINTOSH MONKS AIR CONDITIONING 27166 TERRYTOWN ST P O BOX 128 MENIFEE, CA 92586 SUN CITY, CA 92586 Applicant Phone:9516794502 GARY MONK License Number: 912194 MONKS AIR CONDITIONING P0 BOX 128 SUN CITY, CA 92586 Fee Description gty Amount(SI 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 staled,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_81dg Pemiit_Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ I am exempt from licensure under the Contractors'State License Law for th 1 hereby affirm under penalty or perjury that I am licens id 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 it Professions Code license is in full force and off t. which I must have resided for at least one year prior to completion c License Class �O Licens No. 2[ improvements covered by this permit,I cannot legally sell a structure that I haw Expires3_3I_ OL Signatu built as an owner-building if 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 Code,is available upon request when this application t: submitted or at the followinb Web site: ❑ I hereby affirm under penalty of perjury one the ollowing declarations: httol/wwwleeinfo.ca oov/calaw.html. I have and will maintain a certificate of consentt of s If-insure for workers' compensation,issued by the Director of Industrial Relati 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 orAuthoriied Agent Pokey# ❑ By my Signature below, I certify to each of the following: I am the propery 1 have and will maintain workers' compensation ins irance, as required by owner or authorized to act on the property owner's behalf. 1 have read this section 3700 of the Labor Code, for the performance of I he work for which this application and the information I have provided is cored. I agree to compg permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city andcounty ordinances and slate laws relating to building C construction.I authorize representatives of this city or county to enter the above Cartier identified property for the igspection purposes. Policy#1Z— /r/D� I Z Expires j- Date Property Owner orAuthodzed Agent (This section need not be completed if the permit is for CI Business License# '] one-hundred dollars($100)or less) City i 1 � HAZARDOUS MATERIAL DECLARATION 41 certify that in the performance of the work for which his permit is issued,I shall not employ any persons in any manner so as to t ecome subject to the Will the applicant or future)building 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 specified on the Hazardous Materials Information Guide? Code,e�n ll f hwi mply with tho..e provisions. ❑YES NO Appli Date; 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 District(SCAQMD)?See permitting checklist COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES �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 10oD feet of the outer DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounds ofaschool? LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES ZNO 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 unde)tand my requirements under the State of agency for the performance of the work which this pertmit is issued (Section California Health Safety. e,Section 25505 and 25534 concerning 3097 Civil Code) hazardous mate Ire oril . OWNER BUILDER DECLARATIONS ❑YES NO I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date. License Law for the reason(s)indicated below by the checkmark(s)I have placed PROk-RTY;0AAa9K AUTHORIZED AGENT next to the applicable item(s)(Section 7031.5.Business and Professions Code: EPA RENOVATION.REPAIR AND PAINTING fRRP Any city or county that requires a permit to construct, alter,Improve, demolish, ) or repair any structure, prior to its issuance, also requtres;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(Chapter19(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 firths and comply with she is exempt from licensure and the basis for the alle'rged 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-idisturbing 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.gowlead or contact the National Lead Information Center at ❑ I, as owner of the property, or my employees with wages as their sole 1-800424-LEAD(5323). compensation,will do( )all of or( )porting of the work,land the structure 1s not Intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law dots not apply to an Towner of a property ❑An EPA Lead-Safe Carried 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 of improved for the Firm Certification o.: purpose of sale). N ❑ 1, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Fran 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 tdan 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). If your project does not comply with EPA RRP rule please fill out the RRP BUILDING & SAFETY PERM IT/PLAN CHECK APPLICATION, Menifee DATE PERMIT/PLAN CHECK NUMBER Ic�`O SAD 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 O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES - DESCRIPTION OF WORK P(C 3_ C) -(un `G�JeEv— S I5 211 I�X `4 PROJECT ADDRESS ASSESSOR'S PARCEL NUMBER 33Co - r�I E a_ LOT TRACT l OWNERNAME // //'' j C` ^'�L� /y-p ADDRESS Z-\ 1 GC-2 �x n �1 '� ( ' Cl+ l Z 5 S PHONE (�5I / 2�5D l/ EMAIL APPLICANT NAME („ y- . .. _ 11.V- ADDRESS 3cc�/I SW M tl W ►�/l�er� I �e�e CA L R LJI PHONE ) (P;7q'-1l 5Q2 EMAILI'Y 0nY S0 i y^9D g n-0-: .{ • com /� CONTRACTOR'S NAME UCJ � I- I M O . K,�� JJ OWNER BUILDER? O YES NO BUSINESS NAME .01'1 I ADDRESS I q25 PHONE ( "1 S!) LOIf,�1� EMAIL mCn Ka S •I r A' n �m 3 r - • CONTRACTOR'S STATE LIC NUMBER '�/I2�`/ LICENSE CLASSIFICATION C20 VALUATION$ 5� nD SO FT L SO FT / APPLICANT'S SIGNATURE DATECITY STAFF USE ONLY DEPARTMENT DISTRIBUTION9 CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE k10 PAIDAMOUNT 0CA.SH OCHECK# 0CREDIT CARD VISA/MC AMOUNT PLAN CHECK FEES PAID AMOUNT O 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&SFfety Department 29714 Haun Rd. Menifee, CA 92586 951-672-5777 www.cityc finenifee.us Inspection Request Line 951-246-6213 ^n m n a ?� O o 0 0 0 T D ? 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