PMT16-03975 City of Menifee Permit No.: PMT16-03975
29714 HAUN RD. Type: Residential Mechanical
-1ACCELA> MENIFEE, CA 92586
MENIFEE Date Issued: 1210612016
P E R M I T
Site Address: 29300 CARMEL RD, MENIFEE, CA 92586 Parcel Number: 338-071-004
Construction Cost: $6,400�00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT,3-TON, 14 SEER, SINGLE STAGE SPLIT A/C 70,000 BTU FURNACE
Work:
Owner Contractor
ANNE GREENE MONKS AIR CONDITIONING
29300 CARMEL ROAD P 0 BOX 128
MENIFEE,CA 92586 SUN CITY,CA 92586
Applicant Phone:9516794502
TIFFANI SELLERS License Number:912194
MONKS AIR CONDITIONING
P 0 BOX 128
SUN CITY, CA 92586
Fee Description oty Amount($
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 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.
Ak8k1g_Perrnit—TennpIate.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION 0 1 am exempt from licensure under the Contractors'State License Law for I
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 license is in full force and eff which I must have resided for at least one year prior to completion
Ul.cense Class C, L! No. )2-IqLl improvements covered by this permit,I cannot legally sell a structure that I he
Expires Signatu built as an owner-b0i ding if it has not been constructed in its entirely by licens
3-5 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 appl;catlon
submitted or at the followling Web-site:
0 1 hereby affirmi under penalty of perjury one of the following declarations* leginfo.ca.govicalaw.htmi.
I have and will maintain a certificate of consent of self-insure for workers; hit
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
'4 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 III
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
perridt is issued.My workers!compensation insurance carder 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%
Carder I Identified property for the inspection purposes.
Policy#12 --700— /2— Expires Proliierty Owner or Authorized Agent Date
(This section need not be completed if the permit is for City Business License# 0:554e-79
one-hundred dollars($100)or less)
4 1 certify that in the performance cf the work for which IN*a permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not emplo 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 Califomla,and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensatici provisions of Section 3700 of the Labor amounts s ecified on the Hazardous Materials Information Guide?
Code I shall f wi mply with those provisions. DYESVO
Appli nt, Date; 02 Will the intended.use of the building by the applicant or future building
ZZ = I occupant require a permit for the construction or modification from South
WARNING: 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 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 FOWIN SECTION 3706 OF. THE bounda f school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES VN80
CONSTRUCTION LENDING AGENCY 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 Califom!iusFme:a11tth A Safety C9qe,Section 25505 and 25534 concerning
3097 Civil Code) hazardc3us qMate
OWNER BUILDER DECLARATIONS DYES NO7J nZ�f� _Date
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the reason(s)indicated below by the checkmark(s)I have placed 4 EIR AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5. Business and Professions Code:
Any oily or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION,REPAIR AND PAINTING fRRP)
or repair any structure, prior to its issuarrice,also requires the applicant for the 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 -1978
provisions of the Contractor's State License Law(Chapter 9(commencing with receiving compensation for most work that disturbs paint in a pre
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.1icensure,and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 703'1.5 by any Applicant forp permit subjects the applicant to managers who do the paint-disturbing�vork themselves or through their
a civil penalty of not mom than($5U0)J 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( 1,porting of the work,and the structure is
not intended or offered for sale.(Section 70",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%(ill have the burden of proving that it was not built or improved for the
purpose of sale). Firm Cer-Iffication No.:
0 1, as owner of the property a.n exclusively contracting with licensed 0 No EPA Lead-Safe Certified Firm is req.ulred 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 improves thereon, and who contracts for the projects with a
TION
G SAFLETY PERM.,1111, PLAN' CHILCK APPLICA,
FB.1i_1L 7D,
k- Wenifee
A I;ibqbn
DATE PERMIT/PLAN CHECK NUMBER PM�,a
TYPE: 0 COMMERCIAL )i RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
SUBME: 0 ADDITION 0 ALTERA71ON 0 DEMOLMON -0 ELECTRICAL XMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 4NhC- rkn nuf Caxrv_,(- 3-o 14
�&_ -7 0 L S ) F1 �Lr-la LO�
vla I, mili,fez LL2_z5_&_
PROJECTADDRESS t
ASSESSOWS PARCEL NUMBER LOT TRACT
CRY me 'Tee
OWNERNAME Building 08, SXty Depi.
, C As
ADDRESS :� J-Y-)-k— n-S
PHONE EMAIL
APPLICANT NAME o fty,
CIZ5R4
ADDRESS M r
PHONE EMAILMOn KSa I r tV mcco cbm
CONTRACTOWS NAME OWNERBUILDER? 0YES,kO
BUSINESSNAME 11 vi i Y10
ADDRESS I A 22594
PHONE (qW 6L OL:450
I— EMAIL rylOnV-S4Z C-0 ryN
CONTRACrOR'S STA�E LIC NUMBER, P12-1qq _ UCENSE CLASS]FICATION CLIO
VALUATION$ (0, Ltoo 2�� - SO FT LSQFT
APPUCANrS SIGNATURE DATE-
-- - I I CITY 0-F MENIFEE BUSINESS LICENSE NUMBER
DEPARTMENT DISTRIBUTION
BUILDING pLANNjtjG ENGINEERiivo RRE I GREEN SMIP
INVOICE PAJD AMOUNT OCREDTr CARD VISA/MC
AMOUNT ;-aw- w I 1 0 CASH 0 CHECK#
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VLWMC
OWNER BUILDER VERIFIED OYES 0 No DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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