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PMT16-02342 City of Menifee Permit No.: PMT16-02342 29714 HAUN RD. S�CCEL/_> MENIFEE,CA 92586 Type: Residential Mechanical MENIFEE Date Issued: 07/21/2016 PERMIT Site Address: 26208 BRANDYWINE DR, MENIFEE, CA Parcel Number: 335-142-014 92586 Construction Cost: $7,200.00 Existing Use: Proposed Use: Description of HVAC CHANGE OUT 2.5-TON 14 SEER OVER/UNDER HEAT PUMP Work: Owner Contractor PAT PADGETT MONKS AIR CONDITIONING 8586 MERCED CIRCLE,#1008D P O BOX 128 HUNTINGTON BEACH, CA 92646 SUN CITY, CA 92586 Applicant Phone:9516794502 TIFFANI SELLERS License Number:912194 MONKS AIR CONDITIONING P O BOX 128 SUN CITY,CA 92586 Fee Description City Amount IEl 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_Perrrit_Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ lam exempt from Iicensure under the Contractors'State License Law forth I hereby affirm under penalty or perjury That I am Ilcens d under provisions of fallowing 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 etT which I must have resided for at least one year prior to completion c License Class(= Licensiq No. 2_1 improvements covered by this permit,I cannot legally sell a structure that I haw Expires3-3)— t 8_ Signatu built as an owner-building if it has not been constructed in its entirety by licensee contractors. I understand that a copy of the applicable law, Section 7044 of the 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 of perjury one the sng declarations: httDIANww leginfo ca oovjcalaw htm1. I have and will maintain a certificate of consentt of s d If-inf-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 or Authorized Agent Policy# ❑ By my Signature below; I certify to each of the following: I am the property X 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 he work for which this application and the information I have provided is correct. I agree to compy permit Is Issued.My workers'compensation insurance cardei and policy number are: with all applicable city an&county,ordinances and state laws relating to building Cartier �1 construction.I authorize representatives of this city or county to enter the above �7 i, ) identified property for the Irjspection purposes. G Policy# —_200— I Z Expires l'` "-' I6P Date Property Owner or Authorized Agent (This section need 11ol be completed if the permit is for CI Business License# /^ �7 one-hundred dollars($100)or less) City (2 551p ! 4 1 certify that in the performance of the work for which Phis permit is issued,I HAZARDOUS MATEIk1AL DECLARATION shall not employ any persons in any manner so as to become subject to the Will the applicant or future�ibuilding occupant handle hazardous material or a workers'compensation laws of California, and agree th t if I should become Will containing r haz wPuild material equal to handle that the subject to the workers'compensation provisions of Section 3700 of the Labor amounts containing on the Hazardous Materials Information Guide? Code,I shall f wi mply with tho..e provisions. DYES Ve Apple n • Date; Will the intended use of the building by the applicant or future building occupant require a permit for the construction or modification from South WARNING: FAILURE TO SECU' E WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines ! SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES XNO CIVIL FINES UP TO ONE HUNDRED THOU$AND 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 boundarX of school? LABOR CODE,INTEREST,AND ATTORNEYS FEES ❑YESNC CONSTRUCTION LENDING AGENC'.' 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 cherklist.I understand my requirements under the State of agency for the performance of the wank which this perr it is issued (Section California Health Safety e,Section 25505 and 25534 concerning 3097 Civil Code) hazardous mate I re orti . OWNER BUILDER DECLARATIONS DYE 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 O N AOTHORIZED AGENT next to the applicable item(s)(Section 7031.5.Business and Professions Code: Any city EPA RENOVATION.REPAIR AND PAINTING fRRP or county that requires a permit to construct,alter, improve, demolish, ) 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 Iice;�ed 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 faci*to be RRP-certified firths and comply with she is exempt from Iicensure and the basis for the alle�ed 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-idisturbing work themselves or through their a civil penalty of not more than($500).) employees.For more infomjation about EPA's Renovation Program visit: ❑ I, as owner of the roe www.epa.govAead or contact the National Lead Information Center at property,rty, 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 and Professions Code; The Contractor's State License Law docs not apply to an Towner 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 i of 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 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 Menifee DATE �� �� I 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 DEMOLITION O ELECTRICAL MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBEROFSQUARES ��1yr ^ /t1 DESCRIPTION OF WOPK +YPf� C D /Q I rnw LcL` 1 J 0— 2 ,5 1-4 SOW ov PROJECTADDRESS 2l2) Zo I.Jr Or MILE- qZ2 ASSESSOR'S PARCEL NUMBER 3�/��2 " LOT l , TRACT 3 8-3 k' OWNER NAME ADDRESS C 1^]\&D M �I . PHONE( I T I�f /T> ' ()LI -7LII/EMAIL JA 2 I 2016 C,9 24 APPLICANTNAME -lam Y• - V _ 4` - - ADDRESS 3�S3�o/] �M v rr PHONE rg5l\1 EMAILrC10t1KSOIM tD 9rrw d Corn CONTRACTOR'S NAME C r�/ M oYLK OWNER BUILDER? O YES NO BUSINESS NAME M nVl� I r Col' d o I ADDRESS ///�� 5 GA PHONE (?SI 1 C�� 4 09- /]/ ,EMAIL moral-Su.•Ir Z Prna/Lt • CAm CONTRACTOR'S STATE LIC NUMBER �/!2 1 / 1 LICENSE CLASSIFICATION C2,0 VALUATION$ 7 2-0 SOFT L SQ FT APPUCANrS SIGNATURE DATE CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CRY OF MENIFEE BUSINESS UCENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP OCASH O CHECK p INVOICE PAID AMOUNT I® O CREDIT CARD VISA/MC AMOUNT �U PLAN CHECK FEES PAID AMOUNT 0 CASH O CHECK a O CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Deportment 29714 Houn Rd. 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