PMT17-04400 City of Menifee Permit No.: PMT17-04400
29714 HAUN RD. Type: Residential Mechanical
�A_CCELh? MENIFEE, CA 92586
MENIFEE Date Issued:
12/13I2017
PERMIT
Site Address: 28667 W WORCESTER RD, MENIFEE, Parcel Number: 339-121-005
CA 92586 Construction Cost: $7,041.13
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT,3-TON CARRIER 14 SEER R410A SINGLE STAGE A/C SYSTEM WITH 70K BTU
Work: FURNACE
Owner Contractor
COLLEEN BROOKS MONKS AIR CONDITIONING
28667 W WORCESTER ROAD P 0 BOX 128
MENIFEE, CA 92586 SUN CITY,CA 92586
Applicant Phone:9516794502
TIFFANI MONKS License Number:912194
MONKS AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description OQt Amount ISI
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_Bidg_Penn Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from ficensure under the Contractors State License Law for t
I hereby affirm under penalty or perjury that 1 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_. _Licens Z No. 1 improvements covered by this permit,I cannot legally sell a structure that I he%
Fxplres3-3 Signalu built as an owner-building If it has not been constructed In its entirety by fiaenst
contractors. I understand that a copy of the applicable law,Section 7044 of 0
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application
submitted or at the following Web site:
❑ I hereby affirm under penalty of perjury one of the following declarations: htto•IAwnv.leoinfo.ea.00v/ralawhhnl.
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
penult 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 owners 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 carrier and policy number are: with all applicable coy and county ordinances and state laws relating to buildtt
�f construction.I authorize representatives of this city or county to enterthe abov
Cartier Identified property for the inspection purposes.
Policy#1r G— /b )0— /Z Expires U — I — l V Property Owner or Authorized Agent Date(
(This section need not be completed if the permit is forCity Business License# �351v7 b
one-hundred dollars($1D0)or less)
I certify that in the performance of the work for which this permit E HAZARDOUS MATERIAL DECLARATION
shall I -
shall not emolov 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 ecified on the Hazardous Materials Information Guide?
Code,I shall mply with those provisions..'11 DYES,7NO
Appll a�n� Date. I �i i_ Will the intended.use of the building by the applicant or future building
6 occupant require a permit for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management Dlsbidt(SCAQMD)?See permuting checklis
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines '
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND ❑YES <NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,0DO),IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 10D0 feet of the out(
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounds of a school?
LABOR CODE,INTEREST,AND ATTORNEYS FEES ❑YES XNO
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 mateylijIll re orti
OWNER BUILDER DECLARATIONS DYES N0 .r
I hereby affirm under penalty of perury that I am exempt from the Contractor's Date
License Law for the resson(s)Indicated below by the checkmark(s)I have placed PRO O 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 LRRPI
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-Bustnpss 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 civil penalty of not more than($50(fiJ employees.For more Information about EPA's Renovation Program visit:
roe www.epa.govllesd or contact the National Lead Information Center at
❑ I, as owner of the p p rt% or my employees with wages as their sale 1-800-424-LEAD(5323).
compensation,will do( )all of or( )porting of the work,and the their
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 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 Owmer-
Builder will have the burden of proving that it was not built or Improved for the purpose of sale). Finn Certification No.:
❑ 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 tdan owner of a property
who builds or Improves thereon, and who contracts for the projects with a '
_••_•�_n__._�__n•_._,,_____,_.... u.._..__�.__.J_____.____,...au,-n. nun_.,__•____m_..•.�_ecn
•FETY.PERM IT/PLANAPPLICATION
."Menifee
DATE i 2- 2- PERMIT/PLAN CHECK NUMBER co04
TYPE: O COMMERCIAL X RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL XMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK r1 C- 3•G -+n'1 l cLiri OX i 4�
PROJECTADDRESS � b UY C Lam' P, .I [Av,� 025�- -
ASSESSOR'S PARCEL NUMBER 339 t Z.l 0D57' LOT > 21 TRACT 7SSZ
OWNER NAME ( r
ADDRESS
\ /,,j 2V/�� JU
PHONE (qf J 4a - /i4l} EMAIL ��—
APPUCANTNAME
ADDRESS /3��I\530n Ml uMrr Men i f-ete CA q25�
PHONE (` 5 J ��/I��-15Cr2 A ,� �EEMAIL►rjDnKS0IrtD CY1Gl A • corn
CONTRACTOR'S NAME ( Y- I V I DI JI OWNER BUILDER? DYES NO
BUSINESS NAME 1 I r I bn& onika
ADDRESS //�� S I GA r 5
PHONE NM 6-7 450 2- fn' /EMAIL mbn"Al raD n'la:�,L - Corn
CONTRACTOR'S STATE LLIC NUMBER /`�112 i-/`/ , �A LICENSE CLASSIFICATION
VALUATION$ IDYL 13 SOFT I(oT" LSQFT
APPUCANrS SIGNATURE DATE
DEPARTMENT DISTRIBUTIDN CITY OF MENIFEE BUSINESS UCENSE NUMBER
RURaING PLANNING ENGINEERING FIRE &BEEN SMIP k
AMOUNT ,I(�INVOICE PAID AMOUNT O
O CASH O CHECK# O CREDIT CARD VIWMC
PLAN CHECK FEE@ PAIDAMOUNT GUSH OCHECK# OCREDITCARD VIS.VMC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672.6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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