PMT16-02757 City of Menifee Permit No.; PMT16-02757
29714 HAUN RD.
<A-CCV=LA-> MENIFEE,CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 08/23/2016
P E R M I T
SiteAddress: 27161 WENTWORTH DR, MENIFEE, CA Parcel Number: 336-062-005
92586 Construction Cost: $5,100.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, CARRIER 2.5 TON A/C,3.0 TON ADP COIL SINGLE STAGE A/C SYSTEM
Work:
Owner Contractor
MARIA BARBA MONICS AIR CONDITIONING
27161 WENTWORTH DRIVE P 0 BOX 128
MENIFEE,CA 92586 SUN CITY,CA 92586
Applicant Phone: 9516794502
TIFFANI SELLERS License Number:912194
MONKS AIR CONDITIONING
P 0 BOX 128
SUN CITY,CA 92586
Fee Description QtV Amount
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 building 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_B1dg_Perrn1t-TeMp1ate.rpt Page I of 1
City Of Menifee
LICENSED DE LARATION 0 lam exempt from licen.sure under the Contractors'State License Law forth
I hereby affirm under penalty or perjury that I am licens�d under provi.sions of following reason:
Chapter 9(commencing with section 7000)of Division i 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 aft- which I must have resided for at least one year prior to Completion c
License Class— = Lloenslq No. 2_1qq improvements covered by this permit,I cannot legally sell a structure that I hav,
Expire, 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 DECI ARATION Business and Professions Code,is available upon request when this application I!
[3 1 hereby affirm under penalty of perjury one of the ollowing declarations submitted or at the following Web site:
I have and will maintain a certificate of consent of seffminsure for workers; leginfo.ca.gov/calaw.htmi.
compensation,issued by the Director of Industdal Relat:ms as provided for by
Section 3700 of the Labor Code, for the performance )f work for which this Dale
permit is issued. Property Owner orAuthorized Agent
Policy#
[I By my Signature below, I certify to each of the following: I am the propem
I have and will maintain workers' compensation Insurance, as required by owner or authorized to act on the property owners behalf. I have read thi!
section 3700 of the Labor Code, for the performance of the work for which this application and the infoarlation I have provided Is correcL I agree to compl�
permit is issued.My workers'compensation insurance carder and policy number are: with all applicable city andicounty ordinances and state laws relating to buildinj
Carrier construction.I authorize representatives of this city or county to enter the above
Identified property for the inspection purposes.
Policy# E i Date
xpre 162 i
Property Owner or Authorized Agent
(This section need not be completed if the permit is for 1 -7
one-hundred dollars($100)or less) City Business License# 2�, 62
1 certify that in the performance of le work for which tris permit Is issued,I HAZARDOUS MATERIAL Dr(;LAgA-noN
shall not employ any persons In any inanner so as to I:ecome subject to the Will the applicant or futureibuilding 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
Code I shall mply with thDe provisions. amounts pecified on the:Hazardous Materials Information Guide?
OYES No
Appli ant, Dat�;
Will the Intended use of the building by the applicant or future building
WARNING, FAILURE TO occupant require a permit for the construction or modification from South
SEC WORKERS' Coast Air Quality Managerhent District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAW AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES for guidelines
AND OYES )<No
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($1100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building o, r modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundar faschool?
LABOR CODE,INTEREST,AND ATTORNEYS FEES I]YES )V
No
CONSTRUCTION LENDING AGENCY
I have read the HazardousiMatemal Information Guide and the SCAOMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checktist.I undehitand my requirements under the State of
agency for the performance of the work which this perr�it is Issued (Section Califo
3097 Cl Code) mia Health Safeby Section 25505 and 25534 concerning
Ort Fpqe
hazardous ma )
!Oate I r I.
OWNER BUILDER DECLARATIONS uy"O
I hereby affirm under penailty of perjury that I am exemot from the Contractor's Date�
License Law for the reason(s)indicated below by the checkmark(s)I have placed PRO�1EIkOWNk.P4 A6THORIZED AGENT
next to the applicable item(s) (Section 7031.5.Business and Profess-ions Code:
Any city or county that requires a permit to construct,alter,improve, demolish, EPA RENOVATION,RE
or repair any structure, prior to its issuance, also requires!the applicant for the RPI
The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
permit to file a signed statement that he or she is licensed pursuant to the
provisions of the Contractor's State License Law(Chapterig(commencing with receiving compensation for most work that disturbs paint in a pre-1 978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facil*to be RRP-cerfified firms and comply with
she is exempt from ficensure and the basis for the alle required practices.This includes rental property owners arid property
.�ed exemption. Any
violation of Section 7031.5 by any Applicant for a permit sub).ects the applicant to managers who do the paint-kiisturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program Visit:
0 1, as owner of the property, or my employees with i rages as their sole www.epa.govAead or contatit the National Lead Information Center it
compensation,will do ( )all of or( )parting of the work, and the structure is 1-800-424-LEAD(5323).
not intended or offered for sale.(Section 7044.Business an I Professions Code;
The Contractor's State License Law docs not apply to an Dwner of a property 13 An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort; builds or iml roves the property,
provided that the improvements are not intended or offered or sale.If,however,
the building or improvement is sold within one year of completion,the Owner. Certified Firm Narma:
Builder Will have the burden of proving that It was not built oir improved for the
purpose of sale). Firm Certification No.:
1, as owner of the property an exclusively contracting with licensed El No EPA Lead-Safe Caddo 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 Id'anowner of a property
*io builds or Improves thereon, and who contracts for the projects with a
'�secl contractor(s)pursuant to the Contractors,State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
'USSR
OWMenifee
19111-A tk
DATE PERMIT/PLAN CHECK NUMBERPMU - o'-ry5n
TYPE: 0 COMMERCIAL )4 RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: 0 ADDITION 0 ALTERATION 0 DEMOLITION 0 ELECTRICAL XMECHANICAL
ONEW OPLUMBING ORE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK
cA
PROJECTADDRESS
TRACT city Of Menitac,,
ASSESSOR'S PARCEL NUMBER C)05 LOT qflili'PS' 91 9,tI'MY Uep
OWNER NAME fUja r� r� P-)OL� AUG Z 2 2016
ADDRESS
(2 PHONE Q51 EMAIL
APPLICANTNAME
ADDRESS306W MQLL112�� � d .; mey-�I �et,
PHONE ( — ryw.�A -
EMAIL mon K50 I v
CONTRACTOR'S NAME aC�XV DrLK JILDER? 0 YESJNO
BUSINESS NAME PvjnrjV-� � Pcir Cbndiho 1'
1 jr- 5:� CA Q259q
ADDRESS I Ir r-j Rd
-70 C z
PHONE (C?5D 6, -r- 4,45n9- EMAIL ry -S450 r a
CONTRACrOR'S STATE LIC NUMBER P[2-lqq LICENSE CLASSIFICATION C2-0
1
VALUATION sO.FT L SO FT
APPLICANTS SIGNATURE DATE.
CITY STAFF USE ONLY OF NIENIFEE BUSINESS UCENSE NUNISM
DEPARTMENT DISTRIBUTION C
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP 4 1
IN1701 E IC) PAIDAM:OUNT L�.�() 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
C T
AMOU C�N
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYFS 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&5 1 afety Deportment 29714 Houn Rd. menifee, CA 92586 951-672-6777
1
www.cityofmenifee.us Inspection Request Line 951-246-6213
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