PMT16-02009 City of Menifee Permit No.: PMT16-02009
29714 HAUN RD.
<A—CCELA— MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued:
06/2812016
PERMIT
Site Address: 28870 SNEAD DR, MENIFEE, CA 92586 Parcel Number: 337-391-009
Construction Cost: $7,760.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT,3.5 TON SINGLE STAGE A/C,70,000 BTU FURNACE
Work:
Owner Contractor
MIKE CONNERS MONK'S AIR CONDITIONING
28870 SNEAD DRIVE P O BOX 128
MENIFEE, CA 92586 SUN CITY, CA 92586
Applicant Phone: 9516794502
TIFFANI SELLERS License Number: 912194
MONK'S AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description Oft( 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 carved 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_Pemrit_Tempiate.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ [am exempt from Iicensure under the Contractors'Stale License Law forth
I hereby affirm under penalty or perjury that I am licens following reason:under provisions of '
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 ii
Professions Code licensers in full force and aft which I must have resided for at least one year prior to completion c
License Class _UcensA No. Z[ improvements covered by this permit,I cannot legally sell a structure that I haw
Expires3__3J (R .. 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 following Web site:
❑ I hereby affirm under penalty of perjury one the -Ins mg declarations: htto:!/www.leeinfo.ca eov)calaw.html.
I have and will maintain a certificate of consentt W-ins of s Ifure 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 orAuthodied Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the properq
1 have and will maintain workers' compensation ins irance, as required by owner or authorized to act on the property owner's behalf. I 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 compit
permit is issued.My workers'compensation insurance cardei and policy number are: with all applicable city andicounly ordinances and state laws relating to building
C C , F_ construction.I authorize representatives of this city or county to enter the above.
Carrier � 7! �7 identified property for the Inspection purposes.
Policy#I G--i/r�D- I L Expires �— '— I i Date
Property Owner orAuthor¢ed Agent
(This section need not be completed if the permit is for CI Business License# /f^^ 2 �7
one-hundred dollars($100)orless) City ! ( l: 062 l
1 certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not emolov any persons in any manner so as to Ilecome subject to the Will the applicant or futurejbuilding occupant handle hazardous material or a
workers'compensation taws of California.and agree that If I should become mixture containing a hazar'.dous 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,I �hmWdtith those provisions. ❑YES NO
Appfl anDate; _ 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 SECU4tE 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
($100,000), IN ADDITION TO TYE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF. THE bounda ofa school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES ZNO
CONSTRUCTION LENDING AGENCI i I have read the Hazardous;Material Information Guide and the SCAQMD
hereby affirm that under the penalty of perjury there Is a construction lending permitting checklist.I understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health$ Safety 0 de,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mate 4 Ire orti
OWNER BUILDER DECLARATIONS : DYES NOe
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 PRO O Nk,04A6THORIZED AGENT
next to the applicable item(s)(Section 7031.5. Business acid Professions Code: i
Any city or county that requires a permit to construct,alter,Improve, demolish, EPA RENOVATION,REPAIR AND PAINTING IRRP)
or repair any structure, prior to its issuance, also requires
ithe 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(Chapterl9 (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 Iicensure 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).) 1 employees.For more information about EPA's Renovation Program visit
❑ I, as owner of the roe or www.epa.govi1ead or contact the National Lead Information Center at
p p rty, my employees with wages as their sale 1-800-424LEA.D(5323). icompensation,will do( )all of or( )porting of the work,Iand 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 who, through employees' or personal effort; builds or improves ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
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 o�improved for the Firth Certification No:
purpose of sale).
i
❑ I, as owner of the property an exclusively contracting with licensed 0 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). If your project does not comply with EPA RRP rule please fill out the RRP
F
D
PERMIT/PLAN APPLICATION
, Menifee -iUN 2 8 2016
DATE PERMIT/PLAN CHECK NUMBER
emuo -
TYPE: O COMMERCIAL X RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL XMECHANICAL
C NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK A-C
nx nil
'7.D r-t-n
PROJECTADDRESS 2�2 ' n
ASSESSOR'S PARCEL NUMBER 33 011k LOT 8 TRACT
_OWNER NAME j
ADDRESS�zJy�2��74-2\ n 2 Al I O)Z,— S v u Cap'
hzum cA q20"
PHONE (" ( / )qz2'3 EMAIL
APPLICANT NAME t✓{ Ir _ I LY,
ADDRESS 3�� O5`50 mu lrlr Mere i � CA O25W
PHONE (// 5l\J a:747-q50 -� �EEMAILYnbtlKSRLY'$V f•Yyw • cbyy-1
CONTRACTOR'S NAME !/--�1�� J OWNER BUILDER? O YES NO
BUSINESS NAME J I Y CDrud l o r)
ADDRESS
PHONE "/S � (EMAIL mOnl-Salr a'7 G1►•na-+-L - Go�'''�
CONTRACTOR'S STATE LIC NUMBER 12I/]`7 LICENSE CLASSIFICATION C2-0
VALUATION$ SQ FT k %-k 1ov L SQ FT
APPLICANT'S SIGNATURE DATE
ONLY
DEPARTMENT DWRIBUTION CRY OF MENIFEE BU5INESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP 177
INVOICE PAID AMOUNT
AMOUNT I C� O CASH O CHECK k O CREDR CARD VISA/MC
PLAN CHECK FEES PAID AMOUN7 O GkSH O CHECK# O CREDIT CARD VIWNIC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.city�finenifee.us Inspection Request Line 951-246-6213
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