PMT17-04401 City of Menifee Permit No.: PMT17-04401
_ JA 29714 HAUN RD. Type: Residential Mechanical
�CCEI MENIFEE, CA 92586
MENIFEE Date Issued: 1211312017
PERMIT
Site Address: 25861 MCCALL BLVD, MENIFEE,CA Parcel Number: 339-051-008
92586 Construction Cost: $8,620.38
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT CARRIER 3-TON 16 SEER R410A SIDE x SIDE PKG GAS&ELEC 60K BTU
Work:
Owner Contractor
BRIAN& DEBRA CULLINGWORTH MONKS AIR CONDITIONING
25861 MCCALL BLVD P O BOX 128
MENIFEE,CA 92586 SUN CITY,CA 92586
Applicant Phone:9516794502
TIFFANI SELLERS License Number.912194
MONKS AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description OQt( Amount($1
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 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 cemmenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA Bldg_Permit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from licensure under the Contractors'State License Law for it
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 elf t which I must have resided for at least one year prior to completion
License Class ) Ucens No. 2- Improvements covered by this permit,I cannot legally sell a structure that I he,
Expires 3-3I.! R' Signatu built as an owner-building If it has not been constructed In its entirety by ficens(
contractors.I understand that a copy of the applicable law,Section 7044 of it
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application
submitted or at the following Web she:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: httollwww.leoinfo.ca.00vtcalaw.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 Dale
Section 3700 of the Labor Code,for the performance of work for which this
peril Is Issued. Property Owner or Authorized Agent
Policy# ❑ By my Signature below, I certify 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 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
perk Is Issued.My workers'compensation Insurance writer 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
Carder f� Identified property for the inspection purposes.
Policy#12-7bD- I Z Expires V — — f V Date
Property Owner or Authorized Agent 2�/�., (�
(This section need not be completed If the perk is for City Business License# O J ✓W�b
one-hundred dollar$($100)or less)
4 1 certify that In the performance of the work for which this perk is Issued,I HAZARDOUS MATERIAL DECLARATION
shall not emolov any persons in any manner so as to become subject to the Wig the applicant or future building occupant handle hazardous material or
workers'compensation laws of Calkomla, 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 s e III don the Hazardous Materials Information Guide?
Code,I shall vA mply with those provision1' ❑YES amounts
Appll nt• Date; I 4 Will the intended.use of the building by the applicant or future building
occupant require a peril for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checkliE
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 feel of the out(
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounds ofaschooI?
LABOR CODE,INTEREST,AND ATTORNEYS FEES ❑YES ZO
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.t understand my requirements under the State of
agency for the performance of the work which this permit is Issued(Section CalBomla Health A Safety C e,Section 25505 and 25534 concerning
1 3097 Civil Code) hazardous mate reoorti
OWNER BUILDER DECLARATIONS ❑YES NO
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 0 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(RRPI
or repair any structure,prior to Its Issuance,also requires the applicant for the
perk 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 Stale 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 firs and comply with
she Is exempt from.fcansure.and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 703;1.5 by airy 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($5004 employees.For more information about EPA's Renovafion Program visit:
www.epa.govIlead or contact the National Lead Inforation Center at
❑ I, as owner of the property, or my employees with wages as their sole 1.800.424-LEAD(5323).
compensation,will do( )all of or( j porting 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 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 Fly 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 Fir Certification No.:
purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Fir 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
• PERMIT/PLANAPPLICATION
"Menifee
DATE PERMIT/PLAN CHECK NUMBER - 04,A
TYPE- O COMMERCIAL `-6(RESIDENTIAL C MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL XMECHANICAL
O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK AC (.Ur I--L- I- 3 C f-bn I .Sl.E7Z,
i
51 p . X Irild _ c 25 I- bb II' &it
PROIECTADDRESS 2S I p C C L Z Il U g25sc0
ASSESSOR'S PARCEL NUMBER b�5'I vDk LOT TRACT 3"I 10
OWNER NAME v �'C o fI oy-( a . 'l l\ 7� -7 p/
ADDRESS ZI L-+' 5 . Cn SS I(.l l D I^ P ( , J n I A I C�L'J
PHONE(CI51 / 32b-5118 � I/EMAIL
APPLICANTN r�AME r I Y,ADDRESS /3c�r 5/)5760/] M U I'r I"/�I tr i Fete Cn CYZ59/�
PHONE (L? IP —lf 502 p VEMAILYyDnKSoirtV IY1Gl A . I Obrn
CONTRACTOR'S NAME ��l-I" lI/!O,,nL-K OWNERSUILDER? OYES I JNO
BUSINESS NAME l PCIr Cond i "o ri i
ADDRESS /� 5 V- 'e. I 29 Q25 T
PHONE (L451� 67q— 4450//'' Z // I
EMAIL mankScclr G7 k-r%a.-L • c,Dm
CONTRACTOR'S
STATE LIICNUMBER C]]12I9"y LICENSE CLASSIFICATION C2Q
VALUATION$ O 1 (�W, 5 ) SO FT ��D L SO FT
APPLICANT'S SIGNATURE DATE
CaYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN ' SMIP X
INVOICE PAIDAMOUNT
AMOUNT '�O ID OCASH vCHECK# OCREDIT CAP.D VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
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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