PMT16-02340 City of Menifee Permit No.: PMT16-02340
29714 HAUN RD.
't;kCCEL:A_ MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 07/21/2016
PERM MM T
Site Address: 29154 PEBBLE BEACH DR, MENIFEE, Parcel Number: 338-082-004
CA 92586 Construction Cost: $8,250.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT,2.5-TON 14 SEER SINGLE STAGE SPLIT A/C,70,000 BTU FURNACE
Work:
Owner Contractor
KATHY HARTOG MONKS AIR CONDITIONING
29154 PEBBLE BEACH DRIVE P O BOX 128
MENIFEE, CA 92586 SUN CITY,CA 92586
Applicant Phone:9516794502
TIFFANI SELLERS License Number. 912194
MONKS AIR CONDITIONING
P0 BOX 128
SUN CITY,CA 92586
Fee Description ,O�l Amount(El
Forced-Air or Gravity-Type Furnace or Burner 1 149.00
Air Handling/Condensing Units SFR 1 133.00
Building Permit Issuance 1 2T00
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 Contracted State 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 tali license is in full force and off which I must have resided for at least one year prior to completion c
Ucense Ciass Liven No. Z/ improvements covered by this permit, I cannot legally sell a structure that I hav,
Expim2--5 L- t 2 Signat.r 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 thi
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 ollowing declarations: hrip•/hxww lepinfo ce povjcelaw html.
I have and will maintain a certificate of consent of s If-insure for workers'
compensation,issued by the Director of Industrial Retail 3ns as provided for by Date
Section 3700 of the Labor Code, for the performance f work for which this
perk is Issued. Pro perry Owner or Authorised Agent
Policy# ❑ By my Signature below. I certify to each of the following: I am the property
C I have and will maintain workers' compensation Insurance. as required by owner or authorized to act on the property owner's behalf. 1 have read thk
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 compy
permit is Issued.My workers'compensation insurance carder and policy number are: with all applicable city and;county,ordinances and state laws relating to buildinc
C� construction.I authorize representatives of this city or county to enter the above
Cartier c�-7���7(Jli, ) identified property for the irjspection purposes.
Policy#_' G— / o— / Z Expires 6— — I Date
Property Owner or Authorized Agent
�^ 2�W U
(This section need not be completed If the peril is for City Business License# l J one-hundred dollars($100)or less) b
I certify that in the performance of the work for which is peril is issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ any persons in any manner so as to become subject to the Will the applicant or futureibullding occupant handle hazardous material or a
workers'compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts a III don the Hazardous Materials Information Guide?
CodeZV=
th tho.,e provisions. ❑yESNO
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 SEC 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 DYES �es
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 ofaschoo17
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES VNa0
CONSTRUCTION LENDING AGENCY
I have read the HazardousMaterial 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 Califomia Health Safety e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mate Ire ortl• .
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 checol+ark(s)I have placed PRO O N AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5. Business ar)d Professions Code:
Any city or county that requires a permit to construct,after, improve, demolish, EPA RENOVATION.REPAIR AND PAINTING(RRPI
or repair any structure,prior to its issuance, also requiresithe 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 i9 (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 alleOd 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:
❑ I, as owner of the roe or www.epa.govAead or contact the National Lead Information Center at
property rty, 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 iowner 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/or sale.If,however, Certified Fir 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 of improved for the Fir Certification o.:
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 Contractors 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 C-3ntractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
BU I WINGPERMITIPLAM CHECKAPPLICATI ON
DATE — I I PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL }4 RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL X.MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES -J ��
DESCRIPTION OF WORK AC � 5 I ' G J
G �U
PROJ ADDRESS Z-
I.,ity f IVte ife�
ASSESSOR'S PARCEL NUMBER I ,33 a'O�Z OO`•-1 LOT 5� TRACTIldln-'f�j53is�la f'•
OWNER NAME1 l� I I
ADDRESS /f
PHONE / '> L IEMAILf ��€ Rv
APPLICANT NAME - Y- V . 4`/
ADDRESS
PHONE /yL� p EMAIL rnDnKSOIY'9D ma:0 corn
CONTRACTOR'S NAME U �-I�Y II/IO OWNERSUILDER? OYES NO
BUSINESS NAME M nj�T
ADDRESS
/n I S/ n I r C� GA �25
PHONE l "/S! Lp2" 4 n2- /� /EMAIL rY I-SCAI r Z ►-na--�-L - GD I'�
CONTRACTOR'S STATE LIC NUMBER 9I2 �-/ `7 LICENSE CLASSIFICATION C2,0
VALUATION$ 0,
G-JV
'J5/ �< OD SQ FT Cl\OL L SO FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE 6NL Y
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN , SMIP 1C.
INVOICE �\ PAID AMOUNT O CREDIT CARD VISA/MC
AMOUNT ✓17��' v O CASH OCHECK#
PLAN CHECKFE:•S PAIDAMOUNT OCASH OCHECK# O CREDIT CARD NSA/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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