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PMT17-02788 City of Menifee Permit No.. PMT17-02788 29714 HAUN RD. �A_CCEL/%> MENIFEE, CA 92586 Type: Residential Mechanical MENIFEE Date Issued: 08/07/2017 PERMIT Site Address: 26934 CORTE ADELITA, MENIFEE,CA Parcel Number: 330-292-014 92585 Construction Cost: $5,943.63 Existing Use: Proposed Use: Description of HVAC CHANGE OUT, CARRIER 3.0 TON, 14.0 SEER, R410A SINGLE STAGE SPLIT A/C SYSTEM, Work: 70K BTU FURNACE Owner Contractor PAUL&SUE FITZPATRICK MONKS AIR CONDITIONING 3538 GIRD RD P O BOX 128 FALLBROOK, CA 92028 SUN CITY, CA 92586 Applicant Phone: 9516794502 GARY MONK License Number:912194 MONKS AIR CONDITIONING P 0 BOX 128 SUN CITY, CA 92586 Fee Description Qtv Amount lEl 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 erors 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 staled,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 ❑ lam 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 eft which I must have resided for at least one year prior to completion License Claw t�_Licens No. Z improvements covered by this permit,I cannot legally sell a structure that I he Expires 3-3 i Signatu built as an owner-building ff it has not been constructed in Its entirety by llcens contractors. I understand that a copy of the applicable law,Section 7044 of t WORKERS'COMPENSATION DECLARATION Business and Professions Cade,is available upon request when this application submitted or at the following Web site: ❑ 1 hereby affirm under penalty Dt perjury one of the following declarations: httol/vnvw.leainfo.ca.cov/calaw.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 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 build! — _ construction.I authorize representatives of this city or county to enter the atim Carrier Q p' identified properly,for the Inspection purposes. Policy#12-7b0- I2 Expires V — — O Date Property Owner or Authorized Agent 22�/� (This section need=be completed If the permit is for City Business License# O J ✓YW-72 one-hundred dollars($100)or less) 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 Califomia, 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 edited on the Hazardous Materials Information Guide? Code,I shall mply with those provisions. DYES amounts Appli nt 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 COVERA.3E 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 IN SECTION 3706 OF THE bounds oIfa school? LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES KNO 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.1 understand my requirements under the State of agency for the performance of the work which this permit is issued (Section Califomia Health ASafetyCyy e,Section 25505 and 25534 conoeming 3097 Civil Code) hazardouqNO I re ort g. OWNER BUILDER DECLARATIONS ❑YES 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 OVJNAtP4 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, ERA RENOVATION,REPAIR AND PAINTING fRRPI 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-Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firths and comply with she is exempt from Jicensure.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 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($500).) employees.For more information about EPNs Renovation Program visit ❑ I roe or m employees with wa es as their sole www.epa.govAead or contact the National Lead Information Center at , as owner of the property,rty: Y9 1-800424-LEAD(6323). compensation,well do( )all of or( )poring 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 personal effort,; builds or improves the property, provided that the improvements are r;ot intended or offered for sale.ti,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 itwas not built or Improved for the Firm Certification No.: purpose of sale). ❑ 1, as owner of the property an exclusively contracting with licensed El 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 lid an owner of a property who builds or Improves thereon, and who contracts for the projects with a ,:_____I______________.._..__.._— n._._,,_____,_.... ,..._.._---:-_,I_____.____,....:u,cn. a _.i__,____au BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION + Menifee g DATE - Ij PERMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL JIQ RESIDENTIAL -- MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL VMECHANICAL o NEW O PLUMBING o RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK &C n L I J C> fan ., ��•�•`'�r PROJECTADDRESS > - -r-i Ili _ ��/ ASSESSOR'S PARCEL NUMBER 330Zd120 \� LOT LA TRACT 7i '-kk I OWNERNAME ADDRESS {C 7,5 PHONE Cq�'.��L"CJ! ' la• SGI C5Jz EMAIL APPLICANT NAME & r ADDRESS //3�� 5//30 M� U rr M� l f- CA � R'- PHONE (`7�\J IP/q'`f502• EMAILn->onKSa l r tD g ma-:A . corn CONTRACTOR'S CONTRACTOWS NAME a�l.I" ►v I� L r OWNER BUILDER? O YES NO BUSINESSNAME cMorIV/ r Cbndi ,on I ADDRESS PHONE (C151� 6-76J- 4 /02 /EMAIL mon KSA'I r a7 rnCL; L • Gam CONTRACTOR'S STATE LIC NUMBER "I/2 l`1 LICENSE CLASSIFICATION VALUATION 5 -5.4rl SO.FT 0 2 L SQ FT APPLICANTS SIGNATURE DATE CITYSTAFF USE ONLY DEPARTMENT DISTRIBUTION I _ CITY OF MENIFEE BUSINESS UCEN5E NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE ; LlPAIDAMOUNT AMOUNT • O CASH O CHECK If 0CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH 0 CHECK A 0CREDIT CARD VIWMC OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER 0 YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. 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