PMT16-02094 City of Menifee Permit No.: PMT16-02094
29714 HAUN RD. Type: Residential Mechanical
4ACCELA.. MENIFEE, CA 92586
MENIFEE Date Issued: 07/05/2016
PERMIT
Site Address: 29460 PEBBLE BEACH DR, MENIFEE, Parcel Number: 338-072-017
CA 92586 Construction Cost: $6,480.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT,3-TON 14-SEER SINGLE STAGE SPLIT A/C,70,000 BTU FURNACE
Work:
Owner Contractor
NANCY GRUBER MONK'S AIR CONDITIONING
29460 PEBBLE BEACH DRIVE P O BOX 128
MENIFEE, CA 92586 SUN CITY, CA 92586
Applicant Phone: 9516794502
TIFFANI SELLERS License Number:912194
P0 BOX 128
SUN CITY, CA 92586
Fee Description ON Amount ISI
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_Bidg_Permtt_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ I am exempt from licensure under the Contractors'Stale License Law for th
I 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 I
Professions Code license is in full force and off which I must have resided for at least one year prior to completion c
License Class t�Licens No. Z improvements covered by this permit, I cannot legally sell a structure that I ham
Expires 3"3I_ Signatu built as an owner-building if it has not been constricted in its entirety by license
contractors. I understand that a copy of the applicable law,Section 7044 of th
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application i.
submitted or at the following Web site:
❑ I hereby affirm under penalty is perjury one t the If-insure
g declarations: hlto://www.leoinfo.ca cov/calaw htm1.
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 Cade, 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 propert,
N( 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 thi:
section 3700 of the Labor Code, for the performance of the work for which this application and the information 1 have provided is correct. I agree to compl,
permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city andlcounty ordinances and state laws relating to buildint
C,� construction.I authorize representatives of this city or county to enter the above
Carrier rc.�7<_7 identified property for the inspection purposes.
Policy#1 G— /rJD� I Z Expires �— — I Date
Property Owner or AuthorizedrAgent �X/
l^ 2 5 �7 4J---
(This section need not be completed If the permit is for City Business License t / n J
one-hundred dollars($100)or less) ty �.
4 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 Willworkers compensation laws of California,and agree that if I should become mix the applicant or fhazardouture s m occupant handle hazardous material or a
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 Materials Information Guide?
Code,I shall f ant• hwi mply with those provisions. DYES
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
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 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounds of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES ,B 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 permit is issued (Section California Health Safety Cp e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mate I re orti g.
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 reason(s)indicated below by the checkmark(s)I have placed PRO 0N 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 fRRP)
or repair any structure, prior to its issuLnce, also requires llhe 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 (Chapter.9 (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 firms 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 applicont 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 EPKs Renovation Program visit:
www.epa.gov/lead 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, and 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 ❑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 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 Finn 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
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE _ I J I PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME 0 POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL MECHANICAL
O NEW C PLUMBING C RE-ROOF-NUMBER OF SQUARES -
_ O
DESCRIPTION OF WORK h b 3 ' G I -O
L)I hC� h- `/ S l
PROJECTADDRESS i a CZ
ASSESSOR'S PARCEL NUMBER 0-�-2- 0 LOT TRACT 7�`�O�
OWNER NAME I
I G
BUilding & Safety Dept.
ADDRESS S I —7
PHONE ��/�� Zy 1/� - / !/� � EMAIL JUL 0 5 201E
APPLICANTNAME -L..�{ r - V -tv I'l, • '
ADDRESS 3 S )QM. U�y►%�r
PHONE rg \51 / (,r-;7n-[1J 502 EMAILrf-10 nKSOIr9D rrala ^ CbYY'l
l.�{
CONTRACTOR'S NAME Levy M D x^ OWNER BUILDER? O YES JNO
BUSINESS NAME f r Wn� 'O n I +7
ADDRESS////�� lS C
PHONE ( "J5I J (r,11 - 4501
EMAIL mOnKSGitr a"� P►yla--L • Ca m
CONTRACTOR'S STATE LIC NUMBER C I Z I-/ 1( LICENSE CLASSIFICATION CZO
('�`� b'
VALUATION$ ��/' n� SO FT L SQ FT
APPLICANT'S SIGNATURE fi DATE
CITY STAFF-u'
•
DEPARTMENT DISTRIBUTION CRY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP k
INVOICE PAID AMOUNT
AMOUNT �O ( OCASH OCHECKp OCREDRCARD MSA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK It O CREDIT CARD MSA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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