PMT17-04325 City of Menifee Permit No. PMT17-04325
_ 29714 HAUN RD.
�CCELA? MENIFEE, CA 92586 Type: Residential Mechanical
"'—tP"R— MENIFEE Date Issued: 12/07/2017
PERMIT
Site Address: 27317 SUN CITY BLVD, MENIFEE, CA Parcel Number: 337-282-028
92586 Construction Cost: $5,144.00
Existing Use: Proposed Use:
Description of HVAC CHANGEOUT,CARRIER 2.0 TON, 14 SEER,SINGLE STAGE R410A SPLIT AC SYSTEM
Work:
Owner Contractor
KATHY LANSFORD MONKS AIR CONDITIONING
74360 DESERT BAJADA TRAIL P O BOX 128
MENIFEE,CA 92210 SUN CITY,CA 92586
Applicant Phone: 9516794502
MONKS AIR CONDITIONING License Number.912194
P0 BOX 128
SUN CITY, CA 92586
Phone:9516794502
Fee Description QQt r Amount ISl
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 slated,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_BIdg Permit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from Ilcensure under the Contractors'State License Law for 0
1 hereby affirm under penalty or perjury that I am licensed under provisions of fallowing 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 �Y�license Is In full force and eff t which I must have resided for at least one year prior to completion
License ss Cla _.! I loans No. Z improvements covered by this permit,I cannot legally sell a structure that I ha.
Expires 3-3 i Signatu built as an owner-building if g has not been constructed in its entirety by Iicenst
contractors.I understand that a copy of the applicable law,Section 7044 of if
WORKERS'COMPENSATION DECLARATION Business and Professions Code,Is available upon request when this application
submitted or at the following Web site:
I I hereby affirm under penalty of perjury one of the following declarations: httr):/Aw w.leainfo.ca.eovlcalaw html.
have and will maintain a certificate of consent of set-insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Cade,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 proper
V_ 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 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
CC , - consW ction.I authorize representatives of this city or county to enter the abov
Carder 5 — identified properly for the inspection purposes.
Policy#12- /00— /Z Expires V — I — ( O Date
Property Owner or Authorized Agent(this section need not be completed If the permit is for O/35'w (y
one-hundred dollars($100)or less) City Business License# W�a
4 1 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 futurw 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 ecified on the Hazardous Materials Information Guide?
Code,I shall f mply with those provisions. ❑YES 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 permuting 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 IN SECTION 3706 OF THE bounds ofa school?
LABOR CODE,INTEREST,AND ATTORNEYS FEES ❑YES 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 Califemla Health Safety Cyy e,Section 25505 and 26534 concerning
3097 Civil Code) hazardous mate Ire orti g.
OWNER BUILDER DECLARATIONS - ❑YES NO
I hereby affirm under penalty of perjury that I am exempt from the Contractors Date
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 Cade:
Any city or county that requires a pert to construct, alter,improve, demolish, EPA RENOVATION,REPAIR AND PAINTING(RRP)
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 dicensure.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 for. permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500)4 employees.For more Information about EPNs Renovation Program visit:
www.epa.govAead or contact the National Lead Information Center at
❑ 1, 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 Cade;
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 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 bulk or improved for the purpose of sale). Firm Certification No.:
❑ 1, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Firm is required for this project because:
cont-actors 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
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r : APPLICATION
Menifee
DATE ! L. - I PERMIT/PLAN CHECK NUMBER PMT l V ? � Mengee
Build ng Dept.
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION C ALTERATION O DEMOLITION O ELECTRICAL XMECHANICAL UT Q / 21JI//
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
V
DESCRIPTION OF WORK PCC- LL- r 2 . 5 - e I V e(
PROJECTADDRESS ! �I�• 1� Cf� "1 L:..C�1.7
ASSESSOR'S PARCEL NUMBER 'S'Z,--�—Z 1r Z OZY LOT '21L 4o TRACT "b"
OWNER NAME 4w\ L , �� a
ADDRESS 1�c� c me f l - _ - -Fr , Jn (an c- ,R.L12ZI
PHONE (y'D�� J`J�3 / 0 / 2 EMAIL
APPLICANTINNA/M�E V{ r bj
pv� (`Dp /+,� �7�/�p
ADDRESS n`JcV/ S�)n �JM, U h� M la 1 ( t"l�` CA `�I LJO 4
PHONE (?51) �v7q'-I502 ,n 'EEMAILI'Y onKSOir9V t'Y1Q, j , corn
CONTRACTOR'S NAME U 0-I� M D//-X ,J OWNER BUILDER? OYES NO
BUSINESS NAME MOnl�C / i r I.-�I nd b ( r�++ /�� I
ADDRESS /� S ( l� 92.S 14
PHONE (q51) 6-7q, 4,:5 �J/ - /EMAIL mbnV-safra7 rr%a;--L • GDm
`-/12 CONTRACTOR'S STATE LIC NUMBER 1�]�`7 LICENSE CLASSIFICATION Cz o
VALUATION$ A 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
INVOICE �/., PAIDAMOUNT
AMOUNT 'if 1 1 1
0CASH 0CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92585 951-672-6777
www.citycfinenifee.us Inspection Request Line 951-246-6213
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