PMT18-02279 City of Menifee permit No.: PMT18-02279
29714 HAUN RD. Type: Residential Mechanical
-►�,(7EL/1�. MENIFEE,CA 92586
MENIFEE Date Issued: 0 5/1 01201 8
PERMIT
Site Address: 28243 MEADOWSWEET DR,MENIFEE, Parcel Number. 340-273-002
CA 92584 Construction Cost: $3,731.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT,NEW CARRIER 3 TON, 14 SEER,R410a A/C,CONDENSING UNIT
Work:
Owner Contractor
JIM DITTER MONK'S AIR CONDITIONING
28243 MEADOWSWEET DRIVE P O BOX 128
MENIFEE,CA 92584 SUN CITY,CA 92586
APpllcant Phone:9516794502
TIFFANI SELLERS License Number.912194
MONK'S AIR CONDITIONING
PO BOX128
SUN CITY,CA 92586
Fee Description Oft Amount f51
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 6.65
$167.65
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_Pemilt Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure 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 melded for at least one year prior to completion
License22Class_. _Ucens No. 2 improvements covered by this permit,I cannot legally sell a sbucture that I he
EcpiresJ—. )" 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:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: h�rJMviw.leginfo.ca.gov/calaw.htmi.
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
permit is issued. Property Owner or Authorized Agent
Policy# ❑.By my Signature below, I certify to each of the following: I am the prope
1 have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read ti
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 coml
permit is issued.My workers'compensation insurance varier and policy number are: with all applicable city and county ordinances and stale laws relating to buildi
C 1 r censtruction.I authorize representatives of this dry or county to enter the abox
Carrier r Identified property for the inspection purposes.
Policy#1r G— )W— I Z Expires �— ' '— L v Date
Property Owner or Authorized Agent 2 ('
(This section need net be completed if the permit is for City Business License# O354P R
one-hundred dollars($100)or less)
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 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 s cified on the Hazardous Materials Information Guide?
Code,I shall h mply with those provisions. Q ❑YES 7O
Apple nl• Date; v— (J WIII 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 AN SECTION 3706 OF THE bounds of school?
LABOR CODE,INTEREST,AND ATTORNEYS FEES OYES NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAOMD
I hereby affimt 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 mate Ire ortir
OWNER BUILDER DECLARATIONS ❑YES NO � ��,�//QQ''
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Data 15�Z
License Law for the reason(s)indicated below by the checcmark(s)I have placed PRO DVYNk,04 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,after, 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-Bcsmpas and Professions Code)or that he or residence or childcare facility to be RRP-certNed firths 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 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:
❑ w
ro ww.epa.govilead or contact the National Lead Information Center at
I, as owner of the p perty, 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 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 projec
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). Finn Certification No.:
111
❑ I, as owner of the property an exclusively contracting with licensed No EPA Lead-Safe Certified Finn is required for this project because:
cortactors to construct me 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
BUILDING &SAFETY PERMIT/PLAN CHECK APPLICATION
"Wenifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOUSPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL KMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK frC_ (- ' A( . �n I q-
5Ea E-4 N C )nr1C ! 1 i , LuV (
p J r- /�
PROJECTADDRESS Z-S2-g3 NA a �SVLI -C l�r. ��II.C�.YIt'tt� cizS8 �-
ASSESSOR'S PARCEL NUMBER (�3tio z�-3 0 l LOT � � 1uk f
OWNER NAME
IJ /_ n
ADDRESS /�,�('/�L\\/�'"L� �/j ,Z(-190 I. MAY
PHONE _`/S ( J 2-11�Ip 1 ���� EMAIL imp ved
APPLICANT NAME & r
ADDRESS Men at, CA C?25R4
PHONE (%J! ) Oq—Lf i5O2 � EMAILn-jD '1 KSOirtV Y�.L.I • cbm
CONTRACTOR'S NAME CT i V I Q OWNER BUILDER? O'(ES NO
BUSINESSNAME I ,
jr- Condi bn 1'
ADDRESS //�� S N ( GA L 25 4
PHONE (`�5/� Ogq- 14,50� - EMAIL mOnlcSAt)r a-.) rr-la:L-L • c.Drr1
CONTRACTOR'S STATE LICC NUMBER "//Z 1CILI _ LICENSE CLASSIFICATION CZ0
VALUATION$ 3.I • I SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE
JI
DEPARTMENT DISTRIBUTION CITY aF MENIFEE BUSINESS UCMSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP
INVOICE M PAIDAMOU
AMOUNT O CASH O[HECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# 0CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 19714 Houn Rd.Menifee, CA 92586 951-672-5777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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