PMT18-03252 City of Menifee Permit No.: PMT18-03252
29714 HAUN RD.
ff MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 06/28/2018
PERMIT
Site Address: 26274 CHERRY HILLS BLVD, MENIFEE, Parcel Number: 337-042-020
CA 92586 Construction Cost: $6,481.63
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, NEW CARRIER 2 TON SINGLE STAGE R410a SPLIT A/C WITH 70,000 BTU
Work: FURNACE
Owner Contractor
JOSEPHINE JACKSON-AGOSTA MONKS AIR CONDITIONING
26274 CHERRY HILLS BLVD 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 O�rt Amount IS)
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 fmm 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 ❑ lam exempt from Iicensure under the Contractors'State License Law for,
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing with sectitm 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 etf which I must have resided for at least one year prior to completion
License Class +1 Ucens No. 2-1 improvements covered by this permit,I cannot legally sell a structure that I N
Explres3-3)_Z�O 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 applicetiol
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: httoJlwxnv.leainfo.ca.eovlcalaw.hhnl.
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# D.By my Signature below, I certify to each of the following: I am the prop(
V_ 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 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 corr
permit is Issued.My workers compensation insurance carrier and police number are: with all applicable city and county ordinances and state laws relating to build
CC ff . r^ construction.I authorize representatives of this city or county to enter the abo
Cartier e F. ) identified property for the inspection purposes.
Policy#L2-7 )00— f Z ExpiresJ` I l Date
Property Owner orAuthor¢ed Agent [�
(This section need not be completed if the perm
for City Business License# 03��b
one-hundred dollars($100)or less)
I certify that in the performance of the work for which this permit is issued,) 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 o
workers'compensation laws of CaTomia,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 ecified on the Hazardous Materials Information Guide?
Code,I shall f wi mply with those provisions. ❑YES NO
Appii nt• Date; LAY/ 1. V 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 eheckl
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 ou
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.1 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 ortirl
OWNER BUILDER DECLARATIONS DYES NO //
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date L
License Law for the reasons)indicated below by the checkmark(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 permit to consimcI alter,improve,demolish, EPA RENOVATION,REPAIR AND PAINTING(RRP1
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 contractor
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 700D)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 Iicensure,and the basis for 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 cavil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit:
❑ I, as owner of the property, o, m employees with wages as their sole www.epa.govAead or contact the National Lead Information Center at
compensation,will do I )al f or( )portin o the work,and the structure is 1-800.124LEAD(5323).
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's Stale License Law does not apply to an owner of a property ❑An EPA Lead-Safe Certified Renovator will be responsible for this proje,
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 Finn 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
FETYIPERMIT/PLAN CHECK APPLICATION
Menifee
DATE � PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOUSPA O SIGN
SUBTYPE: O ADDITION CAL TERATION O DEMOLITION C ELECTRICAL MECHANICAL
O NEW O PLUMBING O RE-ROOF-NU�,M1BER OF SQUARES
DESCRIPTION OF WORK PVC 'V -4.:. Ca •) ,r Ll
- �'•L JI}'e
/�"i,�
PROJECTADDRESS - 7 C" 4ia l �Q1? CZ.ScY
ASSESSOR'S PARCEL NUMBER 3J 3�—O"�Z 0:20 q LOT �3
OWNER NAME, 1J� /• / Q `1 - A , - uiilding Dept.
ADDRESS °
PHONE �� ).'�Z�'G7 �� EMAIL
APPLICANT NAME Received
ADDRESS n3�5/3^!onM uMr Men kC CA a25g
PHONE (q5/) aP -/I` 'Lt SVL EMAILI DriKSaIY'tvoYYIQ,LI • Cb&i
CONTRACTOR'S NAME vI G.I' f v l OWNER BUILDER? O YES NO
BUSINESS NAME `I/ n f' Condi 'or) i
ADDRESS //�� S ( lir7 LS
PHONE Lc?51) o,� 7,z5n2 EMAIL /Y1Cn ILSGt•lr G7 @k-YiCLiLL • GDm
CONTRACTOR'S STATE LIC NUMBER 9/Z 1C 4-'],� 6f LICENSE CLASSIFICATION
VALUATION$�,7- �/• �� SO FT �7 2 ! LSO FT
APPLICANT'S SIGNATURE DATE
CITYSTAFFUSECINAY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINE55 UCENSE NUMBER
BuRDMG PLANNING ENGINEERING FIRE I GREEN SMIP x
INVOICE PAIDAMOUNT
AMOUNT 0CASH 0CHECK# OCREDIT CARD VIS{IMC
PLAN CHECK FIFES PAID AMOUNT 0CASH 0CHECK# OCREDIT CARD VISJVMC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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