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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 n m r) = r) > v > � m . a o 0. 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