PMT17-04402 City of Menifee Permit No.: PMT17-04402
29714 HAUN RD. Type: Residential Mechanical
'lkCCEL/-> MENIFEE, CA 92586
MENIFEE Date Issued:
1 211 3/2 01 7
PERMIT
Site Address: 28970 PORTSMOUTH DR, MENIFEE, CA Parcel Number: 339-152-008
92586 Construction Cost: $2,764.25
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT CARRIER SINGLE STAGE FURNACE 90K BTU
Work:
Owner Contractor
ADRIENNE TEDROW MONKS AIR CONDITIONING
28970 PORTSMOUTH DRIVE 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 Qtv Amount($1
Forced-Air or Gravity-Type Furnace or Burner 1 149.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Mechanical 1 7.45
$184.45
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_Bldg_Permit Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from ficensure under the Contractors'State License Law for t
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 Class Ucensii No. improvements covered by this permit,I cannot legally sell a structure that I ha
Expires-:3-- i—! R' Signatu built as an owner-bullring If it has not been constructed In Its entirety by licens
contractors. I understand that a copy of the applicable law,Section 7044 of t
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: htioJAvww.lealnfo ce aovlralaw.html.
1 have and will maintain a certificate of consent of sal- sure for wodcers'
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 prope.
,,.,I I have and will maintain workers' co owner or authorized to act on the property owner's behalf. I have read ti
se compensation insurance, as required is applimflon and the Information I have provided is correct I agree to com;
action 3700 of the Labor Code, for the performance of the work for which this
permit is issued.Myworkers'compensafion insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to buildi
C construction.I authorize representatives of this city or county to enter the atim
Cartier c-X��iF.� Identified property for the inspection purposes.
Policy#12— 7001 /Z Expires y — f -- { O Date
Property Owner or Authorized Agent
(This section need trot be completed If the permit is for O J ✓K/�9one-hundred dollars($100)or less) City Business License#
I 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 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 9pecified on the Hazardous Materials Information Guide?
Cade,I shall mpiy with those provisions. DYES NO
Appli nY Date; I� Z I 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 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 bounda of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑YES VNO
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 i Safety Cppgr[[��(e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mate I re oN
OWNER BUILDER DECLARATIONS ❑YES
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date L
License Law for the reason(s)indicated below by the checkrnark(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 pe,mit to 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 tF.st 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 properly 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).)' employees.For more information about EPA's Renovation Program visit:
❑ 1, as owner of the property, or my employees with wages as their sole www.epa.govAead or contact the National Lead Information Center at
compensation,will do( )all of or( )porting of the work,and the structure is 1-800-424-LEAD(5323). .
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 Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale). Firm 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 td an owner of a property _
who builds or Improves thereon, and who contracts for the projects with a
C � .FETYa PERMIT/•LAN CHECK APPLICATION
Menifee
DATE Z-J- PERMIT/PLAN CHECK NUMBER rl' Da
TYPE: O COMMERCIAL }4 RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL VKMECHANICAL
O1NEE W O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK -H /hc-
PROJECT ADDRESS 2 D t' 1/�1� L7��.- ��1 D r �'I-eY�I �. CA ` 2I JS
ASSESSOR'S PARCEL NUMBER 331 16-2- LOT - TRACT
OWNERNAME I^
ADDRESS / L70 `L
PHONE �cl1-1p1�7 ICJ- OU�j � '/EMAIL
APPLICANTNAME (�{ ,Y_Q O/ b,/
ADDRESS 31530 M t r I �f f_ cry 6 2 F- F
PHONE (` 15 ) (c;7q--150L� p �� �EEMAILIYIonKSoir6) IT1Gl " - Corn
CONTRACTOR'S NAME U �-I! 1 v1 DI J//..``(�,, OWNER BUILDER? OYES NO
BUSINESS NAME J I r l-.Uf� d i 'o n I
ADDRESS 4 lS it I Lir7 r25
PHONE (q5l I 6,_141 4, 02- /�/ 7,EMAIL mbn I_sc i r Z rrta__L • Go m
CONTRACTOR'S STATE LIC NUMBER "1/21-1` LICENSE CLASSIFICATION
VALUATION$ 2 -76>4 Z SQ FT LSQFT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE
AMOUNT PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH CCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER O YES O 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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