PMT18-00008 City of Menifee Permit No. PMT18-00008
29714 HAUN RD. Type: Residential Mechanical
-5A—CCELA? MENIFEE, CA 92586
MENIFEE Date Issued: 01/0 312 01 8
PERMIT
Site Address: 27751 CALLE RABANO, MENIFEE, CA Parcel Number: 336-324-017
92585 Construction Cost: $6,513.94
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, CARRIER 2.5 TON, SINGLE STAGE A/C, 14 SEER,60K BTU FURNACE
Work:
Owner Contractor
KENNETH CLARKE MONKS AIR CONDITIONING
27751 CALLE RABANO P O BOX 128
MENIFEE, CA 92585 SUN CITY, CA 92586
Applicant Phone:9516794502
TIFFANI SELLERS License Number:912194
MONKS AIR CONDITIONING
P0 BOX 128
SUN CITY,CA 92586
Fee Description 0tv Amount lSl
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 commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Pennit_Templale.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ Jam exempt from licensure under the Contractors'State License Law fort
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 t which I must have resided for at least one year prior to completion
License Class Licens No. 2 improvements covered by this permit,I cannot legally sell a structure that I ha
Expires 3-31-!R' Signatu built as an owner-building if it has not been constructed In its entirety by Iicens.
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 t the following for workers
htt? leainfo.m.gov/calaw.html.
1 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 proper
,q I have and will maintain workers compensation insurance, as required by owner or authorized to act on the property owners behalf. 1 have read tt
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 com{
permit is issued.My workers compensation insurance carder and policy number are: with all applicable city,and county ordinances and state laws relating to buildT
CC consWctlon.I authorize representatives of this city or county to enter the abov
Cart �� .ier c-� F Identified property for the Inspection purposes.
Policy#12— 700� /Z Expires y — ' — { U Date
Property Owner orAuthorized Agent 2
(This section need Lot be completed If the permit is for City Business License# O'J ✓0779
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 emolov any persons in any manner so as to become subject to the Will the applicant or fulure-building occupant handle hazardous material or
workers'compensation laws of Caffomia,and agree that d 1 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?
Cade,I shall f A mply with those provisions. DYES amounts
Apple nY Date; Will the intended.use of the building by the applicant or future building
occupant require a permit for the construction or modi0rabon 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 bounds ofaschool?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES 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 pennit is Issued (Section California Heal Safety C e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous male I re orti
OWNER BUILDER DECLARATIONS DYE S NO
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 OVYNAaSIK AUTHORIZED AGENT
next to the applicable Hems)(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 IRRP1
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•Bubinpas 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 7031.5 by any Applicant foCa permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($504j.) employees.For more Information about EPA's Renovation Program visit:
❑ I, as owner of the roe or employees with wa es as their sole www.epa.govAead or contact the National Lead Information Center at
properly,KY, my9 1-800-424-LEAD(5323).
compensation,will do( )all of or( )porting of the work,and the structure Is
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort; builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Cerlified Firm Name:
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or Improved for the purpose of sale). FirmCertification No.:
❑ I, as owner of the property an exclusively contracting with licensed No EPA Lead-Safe Certified Firm is required for this project bemuse:
contactors to construct the project(Section 7044,Business and Professions -
Code:The Contractor's License Law does not apply td an owner of a property
who builds or Improves thereon, and who contracts for the projects with a
FETY PERMIT/PLAN CHECK APPLICATION
Meniree
DATE I - PERMIT/PLAN CHECK NUMBER �$
TYPE: O COMMERCIAL )6 RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION C ALTERATION •O DEMOLITION O ELECTRICAL XMECHANICAL
O NEW O PLUMBING O RE-ROOF-N UMBER OF SQUARES
DESCRIPTION OF WORK fYC LLX ru-r 2 -� rL%� JI f1f L
S e A/c- i4-o 5 K 13TU F�)
PROJECTADDRESS ` • ,� I ' 22nC e-N1l Pam- �� �2S8S"
ASSESSOR'S PARCEL NUMBER 3'36 51,"k ��"� LOT '5--y - TRACT 1 "S 3 V 3
I i OWNER NAME jj 1 J City of Menifee
K IBuilding Dept.
ADDRESS /�m-j�
PHONE (T�L WI 0a EMAIL - L
APPLICANT NAME !,� r / L K
ADDRESS I�l 3�5/30/� /M UMr
PHONE (g51) �P `
^7 I?- 50L„ EEMAILrnDtiKSOI Y•eD rY1Q,j - cbrn
CONTRACTOR'S NAME l�l �-I- / v I D,^X OWNER BUILDER? OYES NO
BUSINESS NAME L I r an&4-"onu34
•
ADDRESS 5!! nn � G�r7 ''e. kd l� qZS 'f
PHONE ('�151 LO�Vr X/�J L. /] IEMAIL man ksc i r Z) rna-/I-�l- • C-O rr,
CONTRACTOR'S STATE LIC NUMBER `mil i 2 1 `-1 LICENSE CLASSIFICATION CZ0
VALUATION$ (f 5�3 � C�� SQ FT LSQFT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER V
BUILDING PL4NNING ENGINEERING FIRE GREEN SMIP I X
INVOICE
AMOUNT L. - io I PAIDAMOUNT a 1 0CASH OCHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEEF PAID AMOUNT OCASH OCHECK# OCREDITCARD VEiA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd, Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6113
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