PMT16-03336 City of Menifee Permit No.: PMT16-03336
29714 HAUN RD. Type: Residential Mechanical
'CA—CCIEFLA> MENIFEE, CA 92586
MENIFEE Date Issued: 10111j2016
P E R M I T
Site Address: 26168 BRANDYWINE DR, MENIFEE, CA Parcel Number: 335-142-011
92586 Construction Cost: $7,655.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, 3.0 TON 14 SEER OVER/UNDER HEAT PUMP,5 kW
Work:
Owner Contractor
STANLEYAMON MONKS AIR CONDITIONING
26168 BRANDYWINE 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 DIV Amount(1)
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 BldgPermit-Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION 0 lam exempt from licensure under the Contractors'State License Law for I
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 that, except for my personal residence
Professions Code license is in full force and ff t q which I must have resided for at least one year prior to completion
Li rense Class Licens No. improvements covered by this permit I cannot legally sell a structure that I he
built as an owner-building if it has not been constructed in its entirety by licens
Expires SignetuAa 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 applicatior
submitted or at the following We"ite:
C3 I hereby affirm under penalty of perjury one of the following declarations: http leginfo.camovIcalaw.titmi.
I have and will] maintain a certificate of consent of self-insu for workers'
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 orAuthorized Agent
Policy# 0�By my Signature below, I certify to each of the following: I am the props
)5( 1 have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read 9
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
pennitis issued.Myworkers'compensaton insurance carrierand policy number are: with all applicable City and county ordinances and state laws relating to buildi
'�� F construction.I authorize representatives of this city or county to enter the alam
Carrier 4 — identified property for the inspection purposes.
Policy#/?,--)np- 1'2- Expires Property Owner orAutharized Agent—Date
(This section need—not be completed if the permit is for
one-hundred dollars($100)or less) City Business Ucense# 0:55409
4 1 certify that in the performance of the work for which this permit 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 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 amount M d th He ardous Materials Information Guide?
Code,I shall f Ph mply with those provisions.
MAO 0 YES NO
Date; Will the intended.use of the building by the applicant or future building
Appllll�� occupant require a permit for the construction or modification from South
E TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checkli
COMPENSATION COVERAGE ]IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES XNO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility bewithin 1000 feet of the out
DAMAGES AS PROVIDED FOW IN SECTION 3706 OF THE bounda f school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES 0 Y E S PKNaO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of peijury 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:allth Safe ,Section 25505 and 25534 concerning
us m %CAe
3097 Civil Code) hazardous malte repo ng.t
OWNER BUILDER DECLARATIONS 0 YES NO )
I hereby affirm under penalty of perjury that I am exempt from the Contractor's iM� Date
License Law for the reason(s)indicated below by the checkmark(s)I have placed AUTHORIZED AGENT
next to the applicable item(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(RUP
or repair any structure, prior to its issuarrice,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(Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1 978
Section 7000)of.Divislon 3 of the-Businless 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 far the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant fiar�p permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a chill penalty of not more than($500-y employees.For more Information about EPA's Renovation Program visit:
www.epa.govAead or contact the National Lead Information Center at
13 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.(Sect;on 7044.Business and Professions Code;
The Contractor's State Ucense Law does not apply to an owner of a property D 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 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 or improved for the
purpose of sale). Firm Certification No.:
0 1, as owner of the property an exclusively contracting with licensed D No EPA Lead-Safe Certified Firm is required for this project because:
cant.-actors to construct the project(Section 7044, Business and Professions
Code:The Contractor's License Law does not apply tc;an owner of a property
BUILDING SA�ETY PERMIT/PLAN CHECK APPLICATION
""Menifee
DATE PERMIT/PLAN CHECK NUMBER PM�.O Q 333 C.0
TYPE: OCOMMERCIAL )(RESIDENTIAL 0MULTI-FAIMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL KMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES�
DESCRIPTION OF WORK L±
L110 A- ovv/�C, CL
PROJEcTADDRESS Z&/(,C9 men I-i��o ca
ASSESSOR'S PARCEL NUMBER k -\7— LOT TRACT 3k :W
OWNERNAME &VO—r—�
ADDRESS 11,�9r'gy 70t Manif,p
PHONE (40j(o)871 - loes EMAIL n , '�'afOtY Dapt.
APPLICANT NAME � V, -.orbl Ou 1, 1 1 2016 6125R4
ADDRESS fet (:�q
� V1
PHONE (qV) (=;7q-q5Q2 EMAIL n-ID11 KS01 r 9D CZrn
CONTRACTOWS NAME Laxy MDrl
OWNERBUILDER? OYES JNO
BU �ri i Y'O
j -(*,e- I .CA q-25314
ADDRESS r r jlt�n Rd If I
PHONEN55!� CR20
r-- 4509- EMAIL ry1br)V—Sa*IrZ
CONTMCTOR'S STATE LIC NUMBER q121qL4 LICENSE CLASSIFICATION CZ0
VALUATION$7 (�)551 SO FT L SQ FT
i APPLICANTS SIGNATURE DATE
Cj-rY STAFF USE ONLY
DEPARTMENT DISTRIBUTION Lil Y OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE I
C) PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD V[SA1MC
o
PLAN CHECK FE ES PAIDAIV 0 CASH 0 CHECK# OCREDITCARD MWMC
OWNER BUILDER VERIFIED 0 YES 0 No DL NUMBER NOTARIZED LE17ER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityof,menifee.us inspection Request Line 951-246-6213
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