PMT16-02339 Cott' of Menifee Permit No.: PMT16-02339
29714 HAUN RD. Type: Residential Mechanical
<ACCEL/-> MENIFEE, CA 92586
MENIFEE Date Issued:
07121/2016
PfERMIT
Site Address: 26815 CHERRY HILLS BLVD, MENIFEE, Parcel Number: 337-341-013
CA 92586 Construction Cost: $6,350.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT 2.0-TON A/C,45,000 BTU FURNACE
Work:
Owner Contractor
SHARRI SESSLIN MONKS AIR CONDITIONING
1433 MEREDITH ROAD P O BOX 128
FALLBROOK, CA 92028 SUN CITY, CA 92586
Applicant Phone: 9516794502
TIFFANI MONKS License Number: 912194
MONKS AIR CONDITIONING
P 0 BOX 128
SUN CITY, CA 92586
Fee Description ON Amount 151
Fnrred-Air or Graviiv-T/pa Furnace or Bumer 1 '149 00
Air Handling/Condensing Units SFR 1 133.00
5uildina Permit Issuance 1 2Z00
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_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from licensure under the Contractors'State License Law for th
following reason:
I hereby affirm under penalty or perjury that I am licens d 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 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 Licens No. 12_16?
improvements covered by this permit,I cannot legally sell a structure that I hav,
Expires__-31- R Signat.r built as an owner-building rf 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
submitted or at the following Web site:
❑ I hereby affirm under penalty of perjury one of the following declarations: httii,//www.leginfo.m.gov/calaw.html.
I have and will maintain a cerfificate 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 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 propeM
1 have and will maintain workers compensation Ins trance. as required by owner or authorized to act on the property owner's behalf. I have read thk
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'mmpensation insurance cardin and policy number are: with all applicable city andicounly ordinances and slate laws relating to building
1 construction.I authorize representatives of this city or county to enter the above
Cartier f identified property for the lospection purposes.
F�,
Policy#'2--700— l L Expires — "— 149 Date
Property Owner or Authorized Agent
2(This section need not be completed if the permit is for CI Business License it I Cl;>��
one•hundred ty dollars($100)or less)
I certify that in the performance of the work for which rs permit is issued,I ;
shall not emolov any persons in any manner so as to De HAZARDOUS MATERIAL DECLARATION
became subject to the Will the applicant or future±building occupant handle hazardous material or a
workers'compensation laws of Califomia, and agree thpt if I should became mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts s ecified on the Hazardous Materials Information Guide?
Code,I shall wi mply with tho:.e provisions. DYES NO
Appii ant• 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 SECUI. E WORKERS' Coast Air Quality Management District(SCAOMD)?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 THOUISAND 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 NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous;Matedal Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I undetstand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health Safety F,yy e,Section 25505 and 25534 mnceming
3097 Civil Code) hazardous matef Ire orti,g.
OWNER BUILDER DECLARATIONS ❑YES NO`
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 PROkRT<0dNAa9KAUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5. Business and Professions Code: i
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 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 jnost 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 facllitY to be RRP-certified firms and comply with
she is exempt from licensure and the basis for the alle'rged 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 patntjdisturbing work themselves or through their
a civil penalty of not more than($500).1 employees.For more infomiation about EPA's Renovation Program visit:
www.epa.govAead 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,land the structure is
not intended or offered for sale.(Section 7044,Business antl Professions Code;
The Contractor's State License Law does not apply to an Ilowner of a property ❑An EPA Lead-Safe Certed 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 kr 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 tnat It was not built or improved for the Firm Certification, a.:
purpose of sale). N
❑ 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, 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 SAPETY PC
ERMIT/PLAN CHECK APPLICATION
a'L
Menifee
DATE -7-1 q—r to PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOUTION O ELECTRICAL XMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK hC D 2 !l A- G
PROJECTADDRESS S I V I
ASSESSOR'S PARCEL NUMBER 33"� 3"A\ 0\( 3 LOT TRACT
_rI Q Building & Sa4ety Opt.
OWNER NAME �nl�/�' rr,�,,, /�/ � /�
ADDRESS 3 In�/111�' I - �/ Fal ISO`^ L-TI
PHONE C1 JD2O 504 ' `( `�1 � 1 /� /EMAIL p 4 J1
APPLICANT NAME L.�{ Y- ^ { 1 I� V - �`
ADDRESS �JcV' ��0 '�1v1 VM1 � M� l �t CA C)�R4
PHONE (` 5 ) ��t?- 502 EMAIL MOnKSa1V-tV9ry- :d Cbrn
CONTRACTOR'S NAME CT T-Y-\/ M D(LIK ,.( - OWNER BUILDER? OYES NO
BUSINESS NAME IY- Cbndt .'bm �7C
ADDRESSJ/� 5 /7 Ai
PHONE [ 75�� LO��l� � //��Zr1 /�� /EMAIL mbnle-Sgilr Z
CONTRACTOR'S STATE LIC NUMBER `•'/I2 I-/ "/ LICENSE CLASSIFICATION
00
VALUATION$�Q SO FT 2 CA L SO,FT
APPLICANT'SS"=uenUee r•/ DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CRY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 1� SMIP K
AMOUNT
INVOICE n q 10
PAID AMOUNT OCASH OCHECK#,�� O CREDITCARD VISA/MC
�7CJ
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK If O CREDIT CARD 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 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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