PMT18-02281 City of Menifee Permit No.: PMT18-02281
29714 HAUN RD. Type: Residential Mechanical
�AGCEI_/k MENIFEE,CA 92586
sml—" MENIFEE Date Issued: 05/10/2018
PERMIT
Site Address: 28271 VIA CASCADITA,MENIFEE,CA Parcel Number: 336-315-008
92585 Construction Cost: $6,250.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT,NEW CARRIER 2.5 TON 16 SEER R410a SINGLE STAGE SPLIT A/C,60,000
Work: BTU FURNACE
Owner Contractor
MICHELLE MARTIRE MONICS AIR CONDITIONING
28271 VIA CASCADITA P O BOX 128
MENIFEE,CA 92585 SUN CITY,CA 92586
Applicant Phone:9516794502
TIFFANI SELLERS License Number:912194
MONWS AIR CONDITIONING
PO BOX128
SUN CITY,CA 92586
Fee Description 6!yt Amount lEl
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 carried on thereunder when in violation of the Building Cade 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_Pem It Template.rpl Page 1 of 1
City Of Menifee
LICENSED DECLARATION O [am exempt from ficensure under the Contractors'State License Law for t
following reason:
I hereby aRrn under penalty or perjury that I am licensed under provisions of
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 efl which I must have resided for at least one year prior to completion
License Class_ n_ No. 2-1 improvements covered by this permit,I cannot legally sell a structure that I he
Expires J�J Signatu Ucens built as an owner-building If it has not been constructed in its entirely,by licens
contractors.1 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: hftpJAvww.leginfo,m.ciov/mlaw.htmi.
I have and will maintain a certificate of consent of set-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
k I 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 carder and policy number are: with all applicable dty and county ordinances and state laws relating to buildi
construction.I authorize representatives of this city or county to enter the aboN
Carder Q p� identified property for the Inspection purposes.
Policy#12--700- I Z Expires V — 1 Date
Property Owner orAuthorized Agent
(This section need itot be completed If the permit is for 0:55l079
one-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 employ 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 dfied on the Hazardous Materials Information Guide?
Code,I shall f hwi mply with those provisions. /J/� a ❑YES 7 NO
Appli ant Date; I�—2 I " l ( 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 cheddi
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 N0
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 Safety C e,Section 255D5 and 25534 concerning
3097 Civil Code) hazaMous mate I re orti
OWNER BUILDER DECLARATIONS DYES NO 27�5'
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 PRo6wrKov1N&p4 AUTHORIZED AGENT
next to the applicable Item(s)(Section 7031.5.Business and Professions Code:
Any city or county that requires a permit to contact,alter,improve, demolish, EPA RENOVATION.REPAIR AND PAINTING fRRPI
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 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)of that he or residence or childcare facility to be RRP-certified 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 fora 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:
❑ vas owner of the property, www.epa.govAead or contact the National Lead Information Center at
compensation,will do( )all of oor my employees with wages as their sole 1-80D-424-LEAD(5323).
( )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). Firm Certification No.:
❑ I, as owner of the property on exclusively contracting with licensed ❑No EPA Lead-Safe Certified Firm Is required for this project bemuse:
contactors to contact the prgjectISectron 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
.,_I----____I._._ _,_..., u.—........:.._.w___-_s____e...:a.rran oor..:...a.......all...n rr.e oo0
BUILDING & �AFETY PERMIT/PLAN CHECK APPLICATION
IMenifee
DATE rJ - PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL 34 RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL XMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK hC
f)a—p, , 12�}ploci SITYt G Lw W
PROJECFADDRESS ZS2 LQ L' KIO I ,'t o2SBS
ASSESSOR'S PARCEL NUMBER LOT -/,A�Y TRACT p 'fee
OWNER NAME
f r BUJIGII IV
ADDRESS
PHONE r - �� LJO
EMAIL
APPLICANT NNA/MME�2 r^ ^ /gyp,.-� �p /'+ �J�p
ADDRESS �J��LrrJ�.J/50 1 v I V 1 f ��/1 L,I 1 J 1 Ct �.P Q ,5
PHONE ( 502 EMAII.rno 1K5Qlrty n-a)-.I - C-br L
CONTRACTOR'S NAME OWNER BUILDER? O YES kO
BUSINESS NAME MorI6 I r nd 0 n l
ADDRESS ( (A q25
PHONE (// 5l� 6-7q- 4S 2- EMAIL man lcSc I r a7 r-1La-U • GOm
CONTRACTOR'S STATE LIC NUMBER gl2l9y LICENSE CLASSIFICATION CZQ
VALUATION$ �iFZ SO FT I �/ L SQ FT
APPLICANT'S SIGNATURE ~ DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN , SMIP
INVOICE PAID AMOUNT 2
AMOUNT "�J •IO 0G45H O CHECK# OCREDR C4R0 VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD MSA/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 951-246-6213
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