PMT16-02123 City of Menifee Permit No.: PMT16-02123
29714 HAUN RD.
{ACCELA_-. MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued:
0 710 712 0 1 6
PERMIT
Site Address: 28042 CALLE VALLARTA, MENIFEE, CA Parcel Number: 336-301-014
92586 Construction Cost: $5,360A0
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT 2.5-TON 14-SEER R410A SINGLE STAGE SPLIT A/C, 70,000 BTU FURNACE
Work:
Owner Contractor
GERI SILVERIA MONKS AIR CONDITIONING
220 TEAGUE DRIVE P 0 BOX 128
SAN DIMAS, CA 92586 SUN CITY, CA 92586
Applicant Phone:9516794502
TIFFANI SELLERS License Number: 912194
MONK'S AIR CONDITIONING
PO BOX128
SUN CITY, CA 92586
Fee Description City Amount I51
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_Permit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION4licens
❑ 1 am exempt from licen sure under the Contractors'State License Law for th
I hereby affirm under penalty or perju licens d under provisions of following reason:
Chapter 9(commencing with section ivision of the Business and By my signature below I acknowledge that,except for my personal residence i
Professions Code license is inand eff which I must have resided for at least one year prior to completion t
Ucense ClassNo. Z� improvements covered by this permit I cannot legally sell a structure that I hav
ExPires3"3I- �1� Signat.rbuilt as an owner-building if It has not been consWcted In its entirety by license
contractors. I understand that a copy of the applicable law, Section 7044 of th
WORKERS'COMPENSATION DEION_ Business and Professions Code,is available upon request when this application i
❑ 1 hereby affirm under penalty of peof the allowing declarations: submitted or at the fallowing Web site:
I have and will maintain a certificatent of s If4nsure for workers' h.UR://www.leginfo.ca.00vjcafaw.html.
compensation,issued by the Director of Industrial Relati ns as provided for by
Section 3700 of the Labor Code, for the performance f work for which this Date
permit is issued. Property Owner orAuthoriied Agent
,,Policy# ❑ By my Signature below, I certify to each of the following: I am the property
.aL I have and will maintain workers' compensation Ins rance, as required by owner or authorized to act on the property owners behalf. I have read this
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 cemply
permit is Issued.My workers'compensation insurance came and policy number are: with all applicable city andcounly ordinances and state laws relating to buildint
Carrier cat construction.I authorize representatives of this city or county to enter the above.
7 Identified property for the i9spection purposes.
Policy#I2---)op— I Z Expires — 14p Date
Property Owner or Authorized Agent
(This section need not be completed if the permit is for �2
one-hundred dollars($1110)or less) City Business License
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 become subject to the
workers'compensation laws of California, and agree that if I should become Will the applicant or thazarbui s m occupant handle hazardous material or a
subject to the workers'compensation provisions of Section 3700 of the Labor mixture containing a hazardous material equal to fo greater that the
Code,I shallahvAttmPIy,�i1th tho..e provisions, i amounts s eclfied on the Hazardous Materials Information Guide?
DYES amounts
Appli ant Date; Will the intended use of the building by the applicant or future building
e construction or modification from
WARNING: FAILURE TO SECURE WORKERS' Cst Air Quality Man get enfor ttDistrict SCAQMD)?See permitting chec
R a klist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES XNO
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 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounda of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑YES , 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 far the performance of the work which this permit is issued(Section California Health Safety C e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mate Ire orti'
OWNER BUILDER DECLARATIONS DYES NO
1 hereby affirm under penalty of perjury that 1 am exempt from the Contractor's Date.
License Law for the reason(s)indicated below by the checkinark(s)I have placed P01ERTKOWN AUTHORIZED AGENT
next to the applicable Items)(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(RRP)
or repair any structure, prior to its issuance, also requiresithe applicant for the
permit to rile 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 Profession's 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 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 Information about EPA's Renovation Program visit:
wages as their sole www.epa.govAead or contact the National Lead Information Center at
❑ I, as owner of the property, or my employees with
compensation,will do I 1-800-424-LEAD(5323).
P 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 dots not apply to an Towner of a property p 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,
the building or improvement is sold within one year of completion, the Owner- Certified Firm Name:
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 Cerfifiad 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 boner 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 clesse fill out the RRP
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
k a,
Menifee
� City of Menifee
uuau Mty Dept.
DATE -7— ((]— I PERMIT/PLAN CHECK NUMBER ® ] 2016
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOLISPA O SIGN
SUBTYPE: C ADDITION O ALTERATION O DEMOLITION O ELECTRICAL X.MECHANICAL R ec o ven`�
O NEW C PLUMBING O RE-ROOF-NUMBER OF SQUARES - IR
DESCRIPTION OF WORK P(C- 2 • jmn , 14 0 S
JI • � 5 � 7�
PROJECTADDRESS 2 M
Effi fCe I, CA
ASSESSOR'S PARCEL NUMBER 33(. 3o a 0\�A LOT 2'2- TRACT
OWNER NAME rTeYJ '
ADDRESS /�1 /-�7 / /�-FCI S Ci `�11
-173
PHONE (�n� l 2 w / ' `t l �/� /EMAIL
APPLICANT NAME -� Ir - V �` ./��{��
ADDRESS 3�� 5/3-0/] /M UrYi%)r M , "t � R`-F
PHONE (7// 5l\J IP !/-l��-1 SL/�� J� EMAILrnotIKSA l r 9D g ry-10W cbm
CONTRACTOR'S NAME U �-I ! I/I OWNER BUILDER? O YES NO
BUSINESS NAME Y 1�1�I�1C.i i ,O n
ADDRESS
//�;n5_7_�0 "j ) rrjjit4n Rd
�/� I r ( GA q25
94
PHONE ( `mils! / CO 1'�l� `T 09- /� /EMAIL mOnIe_Satr a-) rya-/c.L • GDn",
CONTRACTOR'SSTATd LIC NUMBER QI2tgLj LICENSE CLASSIFICATION GZO
' SO FT LSO FT
VALUATION$ 0
APPLICANT'S S'GNAT roc DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTIJN CRY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT � 11 OCREDrrcARD MSA/MC
AMOUNT • \® �""1'to O CASH O CHECK#
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0 YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-6 72-677 7
www.cityofinenifee.us Inspection Request Line 951-246-6213
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