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PMT16-03491 City of Menifee Permit No.: PMT16-03491 29714 HAUN RD. <A-cciELj-,k> MENIFEE,CA 92586 Type: Residential Mechanical MENIFEE Date Issued: 10124/2016 P E R M I T Site Address: 25851 MORGANTOWN WAY, MENIFEE, Parcel Number: 339-133-029 CA 92586 Construction Cost: $6,250.00 Existing Use: Proposed Use: Description of HVAC CHANGE OUT, CARRIER 2.5, 14.0 SEER, SINGLE STAGE SPLIT A/C SYSTEM W170,000 BUT Work: FURNACE Owner Contractor JOYCE BERRY MONKS AIR CONDITIONING 25851 MORGANTOWN WAY P 0 BOX 128 MENIFEE, CA 92586 SUN CITY, CA 92586 Applicant Phone:9516794502 GARY MONK License Number:912194 MONKS AIR CONDITIONING P 0 BOX 128 SUN CITY, CA 92586 Fee Description QtV Amount($ Forced-Air or Gravity-Type Furnace or Bumer 1 149.00 Air Handling/Condensing Units SFR 1 133.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Mechanical 1 14.10 $297.10 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. AkB1dg_Perrnft-Ternplate.rpt Page I of I City Of Menifee LICENSED DECLARATION 0 ]am exempt from feensure under the Contractors'State License Law fort I hereby affirm under penalty or pedury 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 and Py . License is in full force nd If which I must have resided for at least one year prior to compleflon License Clai 0. 7?)2_1QL1 cz.( ) Licensm N improvements covered by this permit I cannot legally sell a structure that I he Expires3-3) / 5� Slglnaturl�� built as an owner-building if it has not been constructed in its entirety by ficens contractors. I understand that a copy of the applicable law, Section 7044 of t WORKERS'COMPENSATION DECLARATION Business and Professions Code,Is available upon request when this applicaflon submitted or at the following Web-sfte: 0 1.hereby affirm under penalty of pedury one of the following cleclarations, leoinfo.m.govicalaw.hfirril. I have and will maintain a certificate of consent of self-insure for workers; _htt :/ANww. 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 certily to each of the following: I am the prope '�( 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 U 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 woTkers'compensabon insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to buildi C5_� F constructlon.I authorize representatives of this city or county to enter the abo% Carrier I — identified property for the inspection purposes. Policy#12-200— /2- Expires <6— 1 — 17 — Property Owner or Authorized Agent—Date (This section need not be completed If the permit is for City Business License 0�354079 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 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 workersT compensatinn provisions of Section 3700 of the Labor amounts � veclfied on the Hazardous Materials Information Guide? Code,I shall Yth mply with those provisions. DYES NO J X Appli Date; Will the intended use of the building by the applicant or future building 4��4 occupant require a permit for the construction or modification from South FAILURE 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 <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 FOR"IN SECTION 3706 OF THE bounder f school? LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES VND CONSTRUCTION LENDING AGENC I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm 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 Health A Safetycme,Section 26505 and 25634 concerning 3097 Civil Code) hazardous mateyfill OWNER BUILDER DECLARATIONS I]YES_,VNO// I r---)< Date I hereby affirm under penalty of pedury that I am exempt from the Contractor's License Law for the reason(s)indicated below by the checkmark(s)I have placed PR4E�041NAVA 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 PAINTINQ(RBPI 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 Division 3 of the-BusinAss and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with she is exempt from Iloensure and the basis for the alleged 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-disturbing�vork themselves or through their a civil penalty of not mom than($500.) employees.For more information about EPA!s 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(6323). compensation,Wll 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 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 0 No EPA Lead-Safe Certified Firm Is required for this project because: cont-actors to construct the project(Section 7044, Business and Professions Code:The Contractoes License Law does not apply td an owner of a property .h. h..M. — 1--. th.— .�ri k� +f. M,+h. "Afln BUILDING SAFETY PERMIT/PLAN CHECI(APPLICATION Wen'fee DATE PERMIT/PLAN CHECK NUMBER PMR0 -7,7 Lm TYPE: OCOMMERCIAL )(RESIDENTIAL C) MULTI-FAMILY OMOBILEHOME 0 POOL/SPA 0 SIGN SUBTYPE: CADDMON 0ALTERATION CDEMOLITION OELECTRICAL X�MECHANICAL CNEW OPLUMBING ORE.ROOF.NUMBEROFSCLUARES DESCRIPTION OF WORK 7-. 51, /4,o r L�� ?ZjQe— PROJEcTADDRESS 2-5&5 MD CLr-) c:�,4 17Z59 2- ASSESSOR'S PARCEL NUMBER -nc� S33 02-q LOT TRACT z s--s-Z OWNER NAME 6E�rf �� ADDRESS i�'f-S OL—Lr�� PHONE (q5/ )30 / -37qa EMAIL APPLICANT NAME RY, — 4] C' ADDRESS IfJTA Ed Mlt6 Ee-t, (�A PHONE rq5) EMAILmorl KSO i r 9D 9 mo-�J - Cbrn CONTRACTOWS NAME a r Dr OWNERBUILDER? OYESJNO L-�/ —LK BUSINESSNAME �40rjkl'� -PCIY- Cbnd I hor) �na ADDRESS q2 5 9 4 PHONE (C?51� 6r7q- 450�2- EMAIL rY1bf)Y—SA'1rZ@ky,,a;I-L . ('Zrv--� CONTRACTOR'S STATE LIC NUMBER C112-11?L4 LICENSE CLASSIFICATION C2-0 VALUATION$ SO.FT L'OFT APPLICANT'S IGNATURE DATE CITYSTAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBEK BUILDING PL4NNING ENGINEERING FIRE GREEN P�---Esmip I I INVOICE PAIDAMOUNT 0 CASH AMOUNT I I I 1 0 CHECK# 0 CREDIT CARD \nSA/MC PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD \IISAIMC OWNER BUILDER VERIFIED OYES 0 No DLNUMBER NOTARIZED LETTER 0 YES 0 NO City of Menifee Building&Safety DLpartmLnt 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofmenifee.us Inspection Request Line 951-246-6213 c r) > m m X m x m M @ m m 0 81 0 m 0 0 0 0 CL N Z 0 > m 3 x m m r+ 0 aq UQ C) 0 r) z m 0 m > Ln mD -< m r) 0 m 0 a =p 0� 7D cr 0 0 0 0 0 rl.) 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