PMT16-02175 City of Menifee Permit No.: PMT16-02175
29714 HAUN RD.
S6ACCELA7. MENIFEE,CA92586 Type: Residential Mechanical
MENIFEE Date Issued: 0711 212 01 6
PERMIT
Site Address: 26188 COLUMBUS DR, MENIFEE, CA Parcel Number: 338-194-014
92586 Construction Cost: $4,900.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT 4.0-TON, 14 SEER A/C, R410A SINGLE STAGE A/C,4.0 COIL
Work:
Owner Contractor
ELSIE DUNN MONKS AIR CONDITIONING
26188 COLUMBUS 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
Phone: 9516794502
Fee Description Qtv Amount tSl
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 6.65
$167.65
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_Pernit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ I am exempt from licensure under the Contractors'State License Law forth
I hereby affirm under penalty or perjury that I am Iicens W under provisions of following reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below 1 acknowledge that, except for my personal residence i
Professions Code license is In full force and eff which I must have resided for at least one year prior to completion c
License Class Ucensjq No. Z improvements covered by this permit, I cannot legally sell a structure that I hav:
Expires3-31- 1-9, Signa` built as an owner-building If it has not been constructed 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 is
❑ I hereby affirm under penalty of perjury one the s submitted or at the following Web site:
mg declarations: httpJAvww.leeinfo ce gov/calaw html.
I have and will maintain a certificate of consentt of s ilfjn If-insu a 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 or Authorized Agent
Policy# ❑ By my Signature below; I certify to each of the fallowing: I am the pmpeM
1 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 I have provided Is correct. I agree to compll
permit is issued.Myworkers'compensation insurance carrier and policy number are: with all applicable city andcounty,ordinances and state laws relating to buildin)
C� construction.I authorize representatives of this city or county to enter the above
Carder identified property for the Ippection purposes.
Policy#12-200- !/Z Expires �— — 149 Date
Property Owner or Authorized Agent
�7
(This section need not 10 )or tested'rf the permit is for CI Business License# C/2? 62 one-hundred dollars($100)or less) City
I certify that in the performance of the work for which his permit is Issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ any persons in any manner so as to t:ecome subject to the Will the applicant or futurejbuilding occupant handle hazardous material or a
workers'oompensat on laws of California, and agree th t If I should become mixture containing a hazarflous material equal to or greater that the
subject to the workers'compensation pr"slons of Section 3700 of the Labor amounts eclfied on the Hazardous Materials Information Guide?
Cade,I shall wi mply with tho,e provisions. ❑YES NO
Appli nY Dates; 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 SEC 1 E WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWF�IL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND ❑YES �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 SECTICIN 3706 OF THE bounds ofascIt 19
LABOR CODE,INTEREST,AND ATTORNEYS FEES ❑YES ZN
CONSTRUCTION LENDING AGENCY I have read the Hazardaus;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 e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mate I re ortl: .
OWNER BUILDER DECLARATIONS ❑YES NO
I hereby afire under penalty of perjury that I am exempt from the Contractor's I Date
License Law for the reasons)indicated below by the checkmadt(s)I have placed PROkffr<04Nkp4 A6THORIZED 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(RRP)
or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is liceTed pursuant to the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law (Chapteryg (commencing with receiving compensation for ost 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 fadilily 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 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 EPKs Renovation Program visit:
❑ 1, as owner of the property, or my employees with Wages as their sole www.epa.gowlesd or contact the National Lead Information Center at
compensation,will do ( )all of or( )porting of the work,land the structure is 1-800-424LEAD(5323).
not intended or offered for sale.(Section 7044,Business anil Professions Code;
The Contractor's State License Law dczs not apply to an ewner 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 corn p
purpose of sale). letion,the Owner-Builder will have the burden of proving that it was not built of improved for the Finn Certification No.:
❑ I, as owner of the property an exclusively contracting with licensed No EPA Lead-Safe Certfied 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 PERIVIIT/PLAN cH ECK APPLICATION
Menifee
DATE ( ' �� PERMIT/PLAN CHECK NUMBER u nn
TYPE: O COMMERCIAL )i RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICALMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF
SQUARES
DESCRIPTION OF WORK J<_ D ' I `f, D S "" "
10 Cv '
PROJECTADDRESS I S
ASSESSOR'S PARCEL NUMBER LOT S� TRACT
OWNER NAME
Building & Safety Dept.
.�
ADDRESS GZ S CL JUL 12 2016
/�
PHONE �1 S1 72' 33!�-o EMAIL
APPLICANT NAME r (� i� r e�v��.�
ADDRESS 30\\550n /M. U Y M e-n i fe e. � eZ5R4
PHONE rq� ) (.;7q� 1 50`2 A EMAIL rnDf1KSO rtD n_a:LA C-byn
CONTRACTOR'S NAME O LK ,.( OWNER BUILDER? OYES NO
BUSINESS NAME C f �r WI1CJ;RDr) i,yla
�7C
94
ADDRESS J/ Ir C� GA ``�
PHONE C�SI� LO 1 'f/ 4 n//'� 2- /�/ /EMAIL rYOnl�Sa'tr u� Prna/�l • CAm
CONTRACTOR'S STATE LLIIC NUMBER "I I2 1C/`Y LICENSE CLASSIFICATION czo
VALUATION$ 4, "( DO o o SQ FT `� ]� L SQ FT
APPUCANT'S SIGNATURE DATE
CITYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN �� SMIP �C.
AMOUNT '1• L Q INVOICE T PAIDAMOUNT l � C. 0CREDIT CARD VIWMC
.l9 O CASH `J CHECK#
PLAN CHECK FEES PAID AMOUNT O CASH O CHEECK# O CREDITCARD VIWMC
OWNER BUILDER VERIFIED OYES 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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