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PMT17-02321 City of Menifee Permit No.: PMT17-02321 29714 HAUN RD. C-�CCEL.A? MENIFEE, CA 92586 Type: Residential Mechanical MENIFEE Date Issued: 0 710 612 01 7 PERMIT Site Address: 26566 CALLE GREGORIO, MENIFEE,CA Parcel Number: 330-280-013 92585 Construction Cost: $4,600.00 Existing Use: Proposed Use: Description of HVAC CHANGE OUT, CARRRIER 3.0 TON, 14 SEER, R410A SINGLE A/C Work: Owner Contractor LORRAINE LAGASSE MONKS AIR CONDITIONING 26566 CALLE GREGORIO P 0 BOX 128 MENIFEE, CA 92585 SUN CITY, CA 92586 Applicant Phone:9516794502 GARY MONK License Number:912194 MONKS AIR CONDITIONING P0 BOX 128 SUN CITY, CA 92586 Fee Description Q1 Amount I$ 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 6.65 $167.66 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. M Bldg_Pennil_Template.rpl Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ lam exempt from licensure under the Conuadom'State License Law for If following reason: I hereby affirm under penalty or perjury that I am licensed under provisions of Chapter 9(commencing with section 7000)of Divisionn 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 _Lfcens No. I2_1 improvements covered by this permit,I cannot legally sell a structure that I hat Expires-2>-3 i_ Signatu built as an owner-building if it has not been constructed in its entirety by licensr contactors. I understand tha,a copy of the applicable law.Section 7044 of ti 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: htto:IMvnv leginfo.ca.aov/ralaw.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 wdrk for which this permit is issued. Property Owner or Authorized Agent Policy# ❑ By my Signature below, I certil';to each of the following: I am the proper 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 th 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 comp permit is issued.My workers'compensation insurance carder and policy number are: with all applicable city and county ordinances and state laws relating to buildir C construction.I authorize representatives of this city or county to enter the abov Carrier F identified property for the inspection purposes. Policy# Expires �— I Date Property Owner or Authorized Agent . (This section need not be completed if the permit is for City Business License# 035079 one-hundred dollars($100)or less) 14 I 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 9 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 amounts 2' /Appli ant• Date; j 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 Distddt(SCAQMD)?See permitting checklis 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 100D feet of the oute DAMAGES AS PROVIDED FOR IIN SECTION 3706 OF THE bounds of school? LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES , NO 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 Ire orti OWNER BUILDER DECLARATIONS DYES NO Z�I I I hereby affirm under penalty of perjury that I am exempt from the Contractors Date I License Law for the reason(s)indicated below by the checkmark(s)I have placed PRO 6AAE,014 AUTHORIZED AGENT next to the applicable Item(s)(Section 7031.5. Business and Professions Code: Any city or county that requires a permit fin construct, alter,improve, demolish, EPA RENOVATION.REPAIR AND PAINTING IRRPI 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 703;1.5 by any Applicant fora permit subjects the applicant to managers who do the paint-disturbing work themselves or through their a civic penalty of not more than($500).) employees.For more Information about EPA's Renovation Program visit: as owner the roe www.epa.gov/lead or contact the National Lead Information Center at ❑ p p rty, or my employees with wages as their sole 1-800424-LEAD(5323). compensation,will do( )all of or( )porting of the work, and the structure is not intended or offered for safe.(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 project 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 Finn 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 Contractor's License Law does not apply IS an owner of a property who builds or improves thereon, and who contracts for the orofects with a t BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION Menifee MTI - 0 7024 DATE Z �t PERMIT/PLAN CHECK-NUMBER TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION b DEMOLITION- O ELECTRICAL MECHANICAL O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES /1 DESCRIPTION OF WORK P(C- CbaDW C)t, D l Ji >-/G PROJECTADDRESS 56(�) Ca. Lc- Crr-e rLC) M I CA 25S ASSESSOR'S PARCEL NUMBER 3'30 7,?0 0 1 -3- LOT VS— TRACT Z k %A 1 OWNER NAME S ADDRESS as PHONE EMAIL APPLICANT NAME r ADDRESS /3�c0,l5/3-70/] ML u Mtn`tn i Eet CA q`-'"RAF PHONE rq5 J (. /q-L S` 02 A EMAILrnDnkSAly-� a-k5w corn CONTRACTOR'S NAME 1.1 rY I I/I O / J OWNER BUILDER? O YES NO BUSINESS NAME J Ir Conde on VL14 ADDRESS /� •'� I � r L•S T PHONE (�I SI� Cp�� ��Z EMAIL mOn l-Sa)r Z h1�L • GDYYI CONTRACTOR'S STATE LIC NUMBER q12 t9y LICENSE CLASSIFICATION C2-0 VALUATION$ q, PC ! SQ FT Z�l_ L SQ FT APPLICANT'S SIGNATURE DATE CITYSTAFFUSEONLY DEPARTMENT DISTRIBUTIDN ® CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN a SMIP INVOICE (^ 5j PAID AMOUNT AMOUNT Y�.'�•� 0CASH 0CHECK# OCREDITCARD \nSVMC PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO City of Menifee Building&Safety Department 29714 Houn Rd. 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