PMT16-01898 City of Menifee Permit No.: PMT16-01898
29714 HAUN RD.
�CCEL/> MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 06/16/2016
PERMIT
Site Address: 28766 GLEN OAKS DR, MENIFEE, CA Parcel Number: 337-205-005
92586 Construction Cost: $6,050.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, 3.0-TON A/C,70,000 BTU FURNACE
Work:
Owner Contractor
RENATE ORTEGA MONK'S AIR CONDITIONING
28766 GLEN OAKS DRIVE P O BOX 128
MENIFEE, CA 92586 SUN CITY, CA 92586
Applicant Phone: 9516794502
TIFFANI SELLERS License Number: 912194
MONKS AIR CONDITIONING
P O BOX 128
SUN CITY, CA 92586
Fee Description 01t v Amount t51
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_Permit_Templale.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'State License Law for the
I hereby affirm under penalty or perjury that I am licens ad 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 fr
Professions Code license is in full farce and eff which I must have resided for at least one year prior to completion o
License Class C�Licens No. Z Improvements covered by this permit,I cannot legally sell a structure that I haw
Expires 3-3I_ 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 thr
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application t:
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the ollowing declarations: htto:/lwww.leeinfo.ca.aov)calaw.hlml.
I have and will maintain a certificate of consent 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 A work for which this
permit is issued. Property Owner orAulhodied Agent
Policy# ❑ By my Signature below, I certify,to each of the following: I am the properq
i( 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 IN,-
section 3700 of the Labor Code, for the performance of I he work for which this application and the information I have provided is correct. I agree to compll
permit is issued.My workers'compensation insurance carriei and policy number are: with all applicable city andicounty ordinances and state laws relating to building
CC�� . consWction.Iauthorize representatives of this city or county to enter the above
Carrier (I 1/�� ) J identified property for the inspection purposes.
Policy#I Expires j- Date
Property Owner orAuthorizedrrAggentt
(This section need Ept 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 Ihis permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ any persons in any manner so as to become subject to the Wm11 the applicant or futurebuilding 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 ecified on the Hazardous Matedals Information Guide?
Code,I shall lythwit mply with those provisions. DYES NO
nt Apple • Date; 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 Dlstridt(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 THOUOAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundarXofa school?
LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous'Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of
agency for the performance of the work which this perrbit is issued (Section California Health$ Safety C e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mateyf I re orti
OWNER BUILDER DECLARATIONS DYES N0
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 PRO 0 Nk,014 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 lthe 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(Chapteri9 (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 alle0d 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 Inforrr♦allon about EPKs Renovation Program visit:
❑ I, as owner of theproperty, or m ern Io employees with a es as their sole �•epa.gov/lead or contact the National Lead Information Center at
Y P Y `{+ 9 1-800-424-LEAD(5323). `.
compensation,will do( )all of or( )porting of the work,l and the structure is
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law dens 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 Finn 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 purpose of sale). Firm Certification No:
❑ I, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044, Busineiss and Professions
Code:The Contractors License Law does not apply tofan 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
•ER.MIT/PLAN CHECK APPLICATION
'-Menifee
DATE I PERMIT/PLAN CHECK NUMBER Q O
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION 0 DEMOLITION O ELECTRICAL MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK kC cbanx
-
' D K 6T 2 L�
PROJECTADDRESS j
ASSESSOR'S PARCE NUMBER �3-7 ZU 0015/ LOT _I TRACT
OWNER NAME Y
ADDRESS
PHONE /^- �[ O �� V/EMAIL
APPLICANT NAME `.1 y��n V . .. S,
ADDRESS 300
M v rr �M �
PHONE (75) 4=:7q—'f 02 EMAILI' 011KSOI✓- rr4cd ' cbm
CONTRACTOR'S NAME aCU M Q j9 OWNER BUILDER? O YES NO
BUSINESS NAME 1 i t CDnd f 'bn l C
r-A
94
ADDRESS
///� lS/�/n ,r C� ( �2•5
PHONE ( q51 J CO (`'{' 7 x//���Zn //]] EMAIL mOnV-SAiIr a"7 ►�nAA- � ' �►'n
CONTRACTOR'S STATE LIC NUMBER C 2- I'l L{ LICENSE CLASSIFICATION C20
VALUATION$ D
SQFT LSO FT
APPucANrs SIGNATURE °ATE LCj-,YSTAFF USE ONLY
DEPARTMENT DISTRIBUTION 11 CITY OF MENIFEE BUSINBS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 1 SMIP k
AMOUNT L. 1() PAID AMOUNT ?� ,10 0CASH OCHECK# OCREDR CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT ODASH OCHECK# OCREDITCARD VISAIMC
OWNER BUILDER VERIFIED OYES O W DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Sbfety Department 29714 Houn Rd, Menifee, CA 92586 951-672-6777
www.city finenifee.us Inspection Request Line 951-246-6213
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