PMT17-00869 City of Menifee Permit No.: PMT17-00869
29714 HAUN RD.
<A-CCEL/> MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued:
03122/2017
PERMIT
Site Address: 26153 LANCASTER DR, MENIFEE, CA Parcel Number: 335-132-011
92586 construction Cost: $7,400.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT,AM STD 2.5 TON 14 SEER R41OA OVER/UNDER HEAT PUMP 5KW HEAT
Work: STRIP
Owner Contractor
NORMA RICCIO MONKS AIR CONDITIONING
26153 LANCASTER DRIVE P O 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 O_yt Amount RI
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_Bldg_Permk_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 sectlen 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_ _Licens No. 2-1L/ improvements covered by this permit,I cannot legally sell a structure that 1 ha
Signatu built as an owner-building if it has not been constructed In its entirety by licens
Expires 3-31-! R'
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: httoJhwnv.leainfo.ca.aov/plaw.html.
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 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 ti
section 3700 of the Labor Cade, 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
construction.I authorize representatives of this city or county to enter the abo%
Carrier Identified property for the inspection purposes.
Policy#12- /b0l l)Z Expires �— I — I _ Date
Property Owner orAuthorized Agent
(This section need not be completed if the permit is for 035(Q79
one-hundred dollars($100)or less) City Business License#
-4 1 certify that in the performance cf 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'compensatic-i provisions of Section 370D of the Labor amounts s ecIII d on the Hazardous Materials Information Guide?
Code,I shall f hwi reply with those provisions. ❑YES " e
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 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 FOR 11N SECTION 3706 OF THE bounda ofa school?
LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES ZNO
CONSTRUCTION LENDING AGENCY 1 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 Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mate Ire orti
OWNER BUILDER DECLARATIONS ❑YES 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 O N a9 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(RRPI
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 7000)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 fdr 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 work themselves or through their
a civil penalty of not more than($5U0).)' - employees.For more information about EPA's Renovation Program visit:
❑ 1, as owner of the roe Cr m employees with wages as their sole www.epa.govAead or contact the National Lead Information Center at
compensation,will do ()all of or( )porting o the work, and the structure is 1-800-024-LEAD(5323).
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 personal effort; builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Finn 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 Firm Certification No.:
purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Firm is required for this project because:
contactors to construct the project(Section 7044,Business and Professions
Code:The Contractors License Law does not apply td an owner of a property _
who builds or improves thereon, and who contracts for the projects with a
Tj
Menifee City Of
enitee
ng roty Dept.
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOUSPA O SIGN 2 ZOi]
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION -O ELECTRICAL MECHANICAL
O NEW O PLUMBING C RE-ROOF-NUMBBEEyR� �OF S(QQUARES 7 ��CIS ved
DESCRIPTION OF WORK kC. 1 ' �� L ' b
PROJECT ADDRESS Lci -In �Jl1Ll r IvI�I� I C, -
ASSESSOR'S PARCEL NUMBER 331�-1 3 2 D r { LOT 13S' TRACT 3 $38
OWNER NAME NIO r C �, ((;;''
ADDRESS /�53 ��( 5 Dr- Lef11 kL . Cil 02,15BLI
PHONE ��/ �� O `"! O I ZD EMAIL
APPLICANTNNA/MME - I� r LK /y)
ADDRESS , I/J\ / O/� Mj UMI I� M� r ' �
PHONE (-/J1 ) (lr-;7 �--i 50L EMAILr rionK50.1 r tV CY 'a.0 • C rn
CONTRACTOR'S NAME U a-_y M o .� J OWNER BUILDER? O YES NO
BUSINESS NAME i � C.DI'1C�I ��YIIVI
J11
34
225
ADDRESS
PHONE /"!S L r+ZaL - • Cam4 monKat �D
CONTRACTOR'S STATE LIC NUMBER PI21 ]`
LICENSE CLASSIFICATION C2-0
er VALUATION$ 4 O � SQ FT L SQ FT
APPLICANTS SIGNATURE DATE
DEPARTMENT DISTRIBUTION CRY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERINGFIRE GREEN 1 ' SMIP
AMOUNTINVOICE -a •' PAID AMOUNT .I(�- O CASH O CHECKn O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VI-WMC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request line 951-246-6213
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