PMT18-02280 City of Menifee Permit No.: PMT18-02280
29714 HAUN RD.
MENIFEE,CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 05/10/2018
PERMIT
Site Address: 29475 CARMEL RD,MENIFEE,CA 92586 Parcel Number: 338-072-021
Construction Cost: $6,723.88
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT,NEW CARRIER 2.5 TON 14 SEER R410a SINGLE STAGE SPLIT A/C,70,000
Work: BTU FURNACE
Owner Contractor
MARGARET SAMPLEY MONICS AIR CONDITIONING
29475 CARMEL ROAD P O BOX 128
MENIFEE,CA 92586 SUN CITY,CA 92586
Applicant Phone:9516794502
TIFFANI SELLERS License Number.912194
MONICS AIR CONDITIONING
P O BOX 128
SUN CITY,CA 92586
Fee Description Oft Amount tbl
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 building 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.mt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from floensure under the Contractors'State License Law for
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 qoP�^license Is in full force and eff which I must have resided for at least one year prior to completion
License Class Ltcens No. Z improvements covered by this permit,I cannot legally sell a structure that I hr
Expires3-31-/R' Signatu built as an owner-building If it has not been constructed in its entirety by licem
contractors.I understand that a copy of the applicable law,Section 7044 of
WORKERS'COMPENSATION DECLARATION __ _ Business and Professions Code,Is available upon request when this applicatioi
submitted or at the following Websits:
❑ 1 hereby affirm under penalty of perjury one of the following decaretions: httoJ/wwav leoinfo.ca.aovloalow.Mml.
I have and will maintain a certificate of consent of -in re for workers'
compensation;Issued by the Director of Industrial Relations as provided for by Dare
Section 3700 of the Labor Code,for the performance of work for which this
pennt Is Issued. Property 0wner or Authorized Agent
Policy# ❑.By my Signature below, I certify to each of the following: I am the prop(
ry I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owners behalf. i have read I
section 3700 of the Labor Code, for the performance of the work for which this application and the Information I have provided is coned I agree to con•
permit is Issued.My workers'compensation Insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to build
construction.I authorize representatives of this city or county to enter the abo
Cartier wit r identified property for the Inspection purposes.
Policy Expiresj — � —I Date
Property Owner or Authorized Agent 2 '
(This section need ot be completed if the permit is for 03 79
one-hundred dollars($100)or less) City Business License
41 certfy that In the performance of the work for which this perrit Is Issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ any persons in any manner so as to become subject to the VA the applicant or future building occupant handle hazardous material o
workers'compensation laws of California,and agree that If 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 s ecifled on the Hazardous Materials Information Guide?
Code,I shall mply with those pro"��'vis//i//ppi�ns. p ❑YES 7NO
Appli nt Date;�/IO Will the Intended.use of the building by the applicant or future building
'/ ySyy�`«/J occupant require a permit for the construction or modification from South
WARNING: FAILURE TO (CURE WORKERS' Coast Air quality Management District(SCAQMD)?See permitting checkl
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 fsciilty be within 1000 feet of the ou
DAMAGES AS PROVIDED FOIR 1N SECTION 3706 OF THE bounda of school?
LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES j�NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Materiel 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 CMI Code) hazardous mate) Ire ort
OWNER BUILDER DECLARATIONS ❑YES NO(
I hereby affirm under penalty of perjury that I am exempt from the Contractor's _Date 3 /�
License Law for the reason(s)indicated below by the checomark(s)I have placed PRO O N AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5.Business and Prof"ons 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.ticersed pursuant to the The EPA Renovation,Repair and Painting(RRP)Rule requires contractor.
provisions of the Contractor's State License taw(Chapter 9(commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7900).of Division 3 of the-Bcsing8s and Professions Code)or that he or residence or childcare facility to be RRP-certl0ed firms and comply with
she is exempt from licensure,and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 703;1.5 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).1 employees.For more Information about EPA's Renovation Program visit:
❑ 1, as owner of the ro or m employees with wages as their sole www.epa.govllead or contact the National Lead Information Center at
compensation,will do()all of or( )porting�work,and the structure Is 1-800-024LEAD(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 pmje�
who, through employees'or personal effort; builds or improves the-property,
provided that the Improvements are not Intended or offered for sale.If,however,
the building or Improvement Is sold within one year of completion,the Owner-
Builder
Finn Name:
Builder will have the burden of proving that It was not built or improved for the purpose of sale). Finn Certification No.:
❑ 1, as owner of the property stn exclusively contracting with licensed ❑No EPA Lead-Sate Certified Finn Is required for this project because:
contactors to construct the prgecl(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-0ERMIT/PLANAPPLICATION
-Menifee
DATE I PERMIT/PLAN CHECK NUMBER a
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION C ALTERATION O DEMOLITION C ELECTRICAL 7WMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK hc- N P ) CCt r L _ 5
1 _0 6 C30'r,pa , S j2 i+ A ?D K T-0 Now
r
PROJECTADDRESS 21(h-75 dcn' _1) I kid ,
ASSESSOR'S PARCEL NUMBER 336 ��'Z�2� � LOT VO TRACT
OWNERNAME NIja
ADDRESS --\ 'L/'I� Cti� �I�,
p(
C(yl\\) 2y-U '`
PHONE� - If9 EMAIL
APPLICANT NAME & r
ADDRESS 3�5/3Q M U r"i cin R d E M Ten i Eee, CA 925R4
PHONE rq5,) �?;7l 'Lf 502 EMAIL/Y'IOnKSO'W eD ►'Y t.t:d CQyyl
CONTRACTOR'S NAME as r M os'/L`K� OWNER BUILDER? OYES kO
BUSINESS NAME
ADDRESS 5 ( CA C125 4
PHONE N511 6_]- 45102. EMAIL n'1OnlcSaira7Gi"-NCLU . GDrrm
CONTRACTOR'S STATE LIC NUMBER P1219L4 LICENSE CLASSIFICATION C20
VALUATION$ Z I EL SQ FT LO C L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN , SMIP X
INVOICE /� PAIDAMOUM 11
AMOUNT ;J ' 10 O CASH O CHECK# O CREDR CARD MSA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYESO NO DLNUMBER NOTARIZEDLETTER O YESO NO
City of Menifee Building&Safety Department 29714 Houn Rd, Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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