PMT17-00089 City of Menifee Permit No.: PMT17-00089
29714 HAUN RD. Type: Residential Mechanical
<ACCEL;N—> MENIFEE,CA 92586
MENIFEE Date Issued: 01/17/2017
PERMIT
Site Address: 25890 CHERRY HILLS BLVD, MENIFEE, Parcel Number: 339-063-013
CA 92586 Construction Cost: $7,000.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, CARRIER 2.5 TON 14.5 SEER PACKAGE GAS&ELEC.40,000 BTU
Work:
Owner Contractor
BARBARA LEVY MONK'S AIR CONDITIONING
25890 CHERRY HILLS BLVD P O BOX 128
MENIFEE,CA 92586 SUN CITY, CA 92586
Applicant Phone:9516794502
TIFFANI SELLERS License Number: 912194
MONK'S AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description Qtv Amount(EI
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 Men'dee.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_Pernit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ I am 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 eff t which I must have resided for at least one year prior to completion
License Class_ Licens No. 21 improvements covered by this permit, I cannot legally sell a structure that I ha
Expires3-3 i / Signatu built as an owner-building 9 it has not been constructed In its entirety by licens
contractors. I understand that a copy of the applicable law. Section 70"of t
WORKERS'COMPENSATION DECLARATION _ Business and Professions Code,is available upon request when this application
submitted or at the following Web-site:❑ I hereby affirm under penalty of perjury one the following declarations: htto•J/www.leainfo.ca cov/dlaw.html.
I have and will maintain a certificate of consentt of self-insure 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 work for which this
permit is issued. Property Owner or Authorized Agent
Policy# ❑.By my Signature below, I certify to each of the following: I am the prope
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 it
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 carder and policy number are: with all applicable city and county ordinances and state laws relating to buildi
C� construction.I authorize representatives of this city or county to enter the abm
Carder ��7����7! _ identified property for the inspection purposes.
Policy# Expires Date
Property Owner or Authorized Agent
(this section need not be completed if the permit is for City Business License#_
one-hundred dollars($100)or less) ty 035 b
I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not emolov 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 1 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 s ecified on the Hazardous Materials Information Guide?
Code,I shall f hwi mply with those provisions. ❑YES, NO
Appli ant• &!�� 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
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 �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 1N SECTION 3706 OF THE bounds ofa school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES VNO
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 Califomia Health Safety C e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mate I re ortirl .
OWNER BUILDER DECLARATIONS DYES 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 PRO O419&PK AUTHORIZED AGENT
next to the applicable item(s)(Secticn 7031.5.Business and Professions Code:
Any city or county that requires a permit to construct,alter, improve, demolish, EPA RENOVATION.REPAIR AND PAINTING IRRP)
or repair any structure, prior to its issuance, 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 Ina pre-1978
Section 7000)of Division 3 of the-Businpss and Professions Code)or that he or residence or childcare facility to be RRP-certified firths and comply with
she is exempt from.licensure,and the basis fdr the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant fora permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit:
❑ 1, as owner of the roe www.epa.gov/lead or contact the National Lead Information Center at
property,rty, 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 O 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.:
❑ I, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Finn Is required for this project because:
contactors to construct the project(Section 7044, Business and Professions
Code:The Contractor's License Law does not apply tdan owner of a property
who builds or improves thereon, and who contracts for the projects with a
• ON
r- City of Menifee
Menifee Building & Safety De
DATE I I PERMIT/PLAN CHECK NUMBER — (WS9A 17 ZO11
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN,, e{Ve(�r
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK A-C 5 J
lzoI(A , ns0 e � PTn
PROJECTADDRESS ��
ASSESSOR'S PARCEL NUMBER 33°I'db3' Ol LOT [�9�� TRACT
OWNERNAME rC I\-
ADDRESS 2-5 Q/ L/ / ) /T - ' ' i
L'/
PHONE )I ' Id W-% - (� 7 EMAIL
APPUCANTNAME U r _ 1 /
ADDRESS 3� 06'3- n o M1 LWV: M � � �`-F
PHONE (`/ 15 IP (1 /!�--T 502 EEMAII.rnorIKSA I Y'9D @ rr)c La • cbrn
CONTRACTOR'S NAME U a- �/ N Ong
OWNER BUILDER? C YES iNO
BUSINESSNAME J ACIr Condi Ron I
ADDRESS /��' f 1S A c �25
PHONE (//I'/ Lp�'�1� `T X//��JLrJ /�' IEMAIL mon ksc�7 r E� rna.�..l- - C.Drr�
CONTRACTOR'S
SSSTATE
/LIIC NUMBER �I I2 1-/`I LICENSE CLASSIFICATION CZ0
VALUATION$ l W() . CO SO FT L SQ FT
APPLICANT'S SIGNATURE -- DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP 7
INVOICE 2,-1 PAID AMOUNT ?�
AMOUNT 'J� 10 0CA,, OCHECK# OCREDR CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD MSA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Noun Rd. Menifee, CA 92585 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
ca
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