PMT16-03147 City of Menifee Permit No.: PMT1 6-03147
29714 HAUN RD. Type: Residential Mechanical
<A—CCELA—> MENIFEE, CA 92586
MENIFEE Date Issued: 09/2312016
P E R M I T
Site Address: 27045 LAMIDIN AVE, MENIFEE, CA 92584 Parcel Number: 360-071-005
Construction Cost: $8.400.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, CARRIER 4.0, 15.0 SEER,SINGLE STAGE SPLIT A/C,70K BTU FURNACE
Work:
Owner Contractor
NANCY SULLIVAN MONKS AIR CONDITIONING
11 5A POPOIA RD P 0 BOX 128
KAILUA, HI 96734 SUN CITY, CA 92586
Applicant Phone:9516794502
GARY MONK License Number 912194
MONWS AIR CONDITIONING
P 0 BOX 128
SUN CITY, CA 92586
Fee Description City Amount($
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 corTection 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_Permitffemplate.rpt Page 1 of I
City Of Menifee
LICENSED DECLARATION 13 1 am exempt from licensure under the Contractors'State License Law fort
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge thaL except for my personal residence
Professions Code license i.s in full force and a which I must have resided for at least one year prior to completion
Li,cerise Clas- r,=Licens No 2-1 QL/ improvements covered by this permit,I cannot legally sell a structure that I he
Signatur(c built as an owner-building if it has not been constructed in its entirety by iicens
ExplreS3__5E_J_9_1_ contractors. I understand that a copy of the applicable law. Section 7044 of I
WORKERS'COMPENSATION DECLARATION Business and Professions Code.is available upon request when this application
submitted or at the followling Welb-site:
0 1 hereby affirm under penalty of pedury one of the following declarations, leoinfo.m.gov/Calaw.htmil.
I have and will maintain a certificate of consent of self-insure for workers: htto:
compensation,issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of w6rk for which this
permit is issued. Property Owner or Authorized Agent
Policy# 0.By my Signature below, I certify to each of the following: I am the prope
IRC I have and wit maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read tl
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 coml
permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to buildi
construction.I authorize representatives of this city or county to enter the abo%
Carrier Identified property for the inspection purposes.
Policy# Expires Pr4erty Owner or Authorized Agent Date
(This section need not be completed if the permit is for City Business License# 07-55(P-79
one-hundred dollars($100)or less)
4 1 certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not emPID any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or
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 is ecified on the Hazardous Materials Information Guide?
Code I h [If thwl mply with those provisions. 0YES 'ZO
Appl, 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
W, FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAOMD)?See permitting checkli
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES J(NO
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 out
DAMAGES AS PROVIDED FORAN SECTION 3706 OF THE bounds f school?
LABOR CODE,INTEREST,AND ATTORNEYS FEES El YES VN30
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affinin 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 He:alltth A Safety Cp4e,Section 25505 and 25534 concerning
usm
3097 Civil Code) hazardou te Ire ortil
OWNER BUILDER DECLAPt.TIONS 0 YES 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 PRO6R-TK0ViN&01�AUTHORIZED AGENT
next to the applicable itern(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 issuaInce, also requires the applicant for the
permit to file a signed statement that he or she is,licensed pursuant to the The.EFA Renovation.Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law(Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1 978
Section 7000).of Division 3 of the-Businjess 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 f6r the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 703).5 by any Applicant forja permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500�-y employees.For more information about EPNs Renovation Program visit:
www.epa.gov/lead or contact the National Lead Information Center at
0 1, 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,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 owner of a property 0 An EPA Lead-Safe Certified Renovator will be responsible for this projec
who, through employees' or personal effort; builds or improves the property,
provided that the improvements are not intended or loffered for 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 that it was not built or improved for the
purpose of sale). Firm Certification No.:
0 1, as owner of the property a n exclusively contracting with licensed 11 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 td an owner of a property
who builds or imoroves thereon. and who contracts for the orolects With a
BU I MING & SAFETY PERM IT/PLAN CHECKAPPLICATION
Menifee
DATE PERMITPLAN CHECK NUMBER
TYPE: C)COMMERCIAL )(RESIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: CADDITION OALTERATION ODEMOUTION OELECrRICAL XMECHANICAL
CNEW OPLUMBING ORE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK (�am-er 4
51ruLe-5kat 5.4,)�U-v hAc -70 1�- &7) EI)CrV7 r Q
PROJE;C;r�ADDRSS
ASSESSOWS PARCEL NUMBER -��.,o O'�-1 (-,O�;— LOT TRACT
OWNER NAME
ADDRESS W'� A q L7-34
PHONE EMAIL
APPLICANT ME (tK
ADDRESS WS.�)O I VU M i k--C, CA CIZ5R4
PHONE ( -7q -10,11 KSO
_q5l) (r-> -Lf502 EMA ILrY
CONTRACTOR'S NAME ER? 0 YES NO
BUSINESSNAME
ADDRESS CA
PHONE LC?5j� 6;;7q� 45n9— EMAIL rY)bn V-S al r ry-LC6—L . CwD ry-�
CONTRACTOR'S STATE LIC NUMBER P12- 1L3 Ll LICENSE CLASSIFICATION C,2-o
0 0 SO FT \0 L Sa FT
U
VALUATION$ B
APPLICANT'S,SIGNATURE DATE
Cj"YSTAFF USE ONLY
DEPARTMENT DISTRIBUTION SMIP 1007 CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE PAIDAMOUNT 0 CASH 0 CHECK 0 CREDIT CARD VISA/MC
AMOUNT I
PLAN CHECK FEES PA!D AMOUNT OCASH O-CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 No DLNUMBER NOTARIZEDLETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-5777
www.cItyofmenifee.us Inspection Request Line 951-246-6213
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