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PMT17-00279 City of Menifee Permit No.: PMT17-00279 29714 HAUN RD. Type: Residential Mechanical <ACCE6/1 MENIFEE,CA 92586 MENIFEE Date Issued: 01/30/2017 PERMIT Site Address: 27099 MONK ST, MENIFEE,CA 92586 Parcel Number: 335-304-006 Construction Cost: $7,300.00 Existing Use: Proposed Use: Description of HVAC CHANGE OUTAMERICAN STANDARD 3.0 TON R410A OVER UNDER PKG HEAT PUMP 5KW Work: HEAT STRIP Owner Contractor LAURNA BURDICK MONKS AIR CONDITIONING 27099 MONK ST P 0 BOX 128 MENIFEE,CA 92586 SUN CITY, CA 92586 Applicant Phone:9516794502 TIFFANY SELLERS License Number: 912194 MONKS AIR CONDITIONING P 0 BOX 128 SUN CITY,CA 92586 Fee Description QtV Amount tEl Forced-Air or Gravity-Type Fumace 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 carded 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_Bldg_Permit_Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ ]am exempt from licensure under the Contractors'State License Law fort 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 which I must have resided for at least one year prior to completion License Class. r J Licens N improvements covered by this permit,I cannot legally sell a structure that I he Expires3-31-i R' Signatu built as an owner-building if it has not been constructed in Its entirety by licens 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 application submitted or at the following Web-site: ❑ 1 hereby affirm under penalty of perjury one of the following declarations: httoJ/www.leginfo.ca.gov/calaw.hlml. I have and will maintain a certificate of consent 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 fallowing: I am the props s, 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 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 CC� , construction.I authorize representatives of this city or county to enter the abo% Carrier c i� J / identified property for the inspection purposes. Policy#12-7b0- I Z Expires �� ' — ! Date Property Owner or Authorized Agent (This section need not be completed if the permit is for 0351P79 one-hundred dollars($100)or less) City Business License# 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 amounts s ecified on the Hazardous Materials Information Guide? Code,I shall hwi mply with those provisions. ❑YES NO Appli nt• Date; I ) 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 OYES )(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 AN SECTION 3706 OF THE bounds ofa school? LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑YES RNO 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 California Health Safety C e,Section 25505 and 25534 concerning 3097 Civil Code) hazardous mate I re orti OWNER BUILDER DECLARATIONS ❑YES NO I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date I License Law for the reason(s)indicated below by the checkmark(s)I have placed PRO 0 N 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/RRP1 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 in a pre-1978 Section 70001 of Division 3 of the-Businpss 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 for 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($500j.y employees.For more information about EPA's Renovation Program visit: rc www.epa.govAead or contact the National Lead Information Center at ❑ I, 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.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property ❑An EPA Lead-Safe Certified Renovator will be responsible for this projec who, through employees' or person^! 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 td an owner of a property who builds or improves thereon, and who contracts for the projects with a . .._..r .. ....•. ,., ........ ♦�_[i_ � _. ♦ r[ [_ ,.____ -...[ 1�..�.. �[ •• • ,.....:u-�"/•eil�l'[-.1 1 l.Il...n,4-000 SAFETYBUILDING & PERMIT/PLAN CHECK APPLICATION t Menifee DATE l �(J—� r PERMIT/PLANCHECK.NUMBER TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN SUBTYPE: O ADDITION O ALTERATION b DEMOLITION- 0 ELECTRICAL MECHANICAL O NEW O PLUMBING 0 RE-ROOF-NUMBER OFSQUARES. DESCRIPTION OF WORK A(C / ,I Y I .�UA/�RE Jd , C +-c)Y) I;y l C).A w y LLnCle,r L 1 cif L�,n S w Iva+Sb'. PROJECTADDRESS G} / 0 4/ LJ ) K en,i ASSESSOR'S PARCEL NUMBER 3/3� 'SQ3� -A 00� LOT � I Z� TRACT � Z ) Z OWNER NAME LLI�I V rnq d I ADDRESS//� ,C,4 7 OS PHONE l-fS/) G^?9- /6/�_ EMAIL APPLICANT NAME '�.�1 r ADDRESS /3�c�' S3o/] M v rr CA q` 5 -1 PHONE (`7Jt ) 4/P;7i?'-7 502„ � EMAILYr' onKSQ J r� I'Y a)A • Cbm ONT U CRACTOR'S NAME CLIP / V I Q L OWNER BUILDER? OYES iNO BUSINESSNAME / PFIr Cone '( D n ( ,104 ADDRESS /� 'ft ( GA 925914 !//�� 5 PHONE ( "/S/ 1 �o�q- 45n2_ EMAIL mon ILSa 1 r rY_LCL L . GD m CONTRACTOR'S STATE LLIIC�NUMBER gl2 jqy LICENSE CLASSIFICATION CZo VALUATION$ 300 0o SQ FT 3 L SO FT APPLICANT'S SIGNATURE DATE CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION to CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING GINEERING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT OCASH OCHECKq OCREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH OCHECKM OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES O NO City of Menifee Building&Safety Deportment 29714 Haun Rd. 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