PMT18-03641 City of Menifee Permit No.: PMT18-03641
29714 HAUN RD.
MENIFEE,CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 07/25/2018
PERMIT
Site Address: 29398 PEBBLE BEACH DR, MENIFEE, Parcel Number: 338-072-012
CA 92586 Construction Cost: $3,487.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT CARRIER SINGLE STAGE A/C&TXV ONLY
Work:
Owner Contractor
JIM&SHIRLEY PIERCE MONKS AIR CONDITIONING
29398 PEBBLE BEACH DRIVE 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 Qtv Amount fbl
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 8ldg_Pennk_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors State License Law fort
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
Prcfassions,Code �,Y license Is In full force and eff t which I must have resided for at least one year prior to completion
License Class t/,�Licens No. 2j improvements covered by this permit,I cannot legally sell a structure that I he
Expires3_31"<�_ Signatu built as an owner-building if it has not been constructed in its entirely by licens
contractors. I understand that a copy of the applicable law,Section 7044 of t
WORKERS'COMPENSATION DECLARATION Business and Pmfessions Code,is available upon request when this application
submitted or at the following Web site:
❑ I hereby affirm under penalty of perjury one the following declarations: httWAvww.lecinfo.ca.aov/calaw.html.
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
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 it
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.Myworkem'compensation Insurance carder and policy number are: with all applicable city and county ordinances and state laws relating to buildi
CCam�. , construction.Iauthorize representatives of this city or county to enter the abot
Cartier e. Q /p� identified property for the inspection purposes.
Policy# Expires U '— — l O Date
Property Owner orAuthorized Agent 2
(This section need Doi be completed If the permit is for O'J
one-hundred dollars($100)or less) City Business License# ��b
41 certify that in the performance of the work for which this HAZARDOUS MATERIAL DECLARATION
rtdy p permit is issued,I
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 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?
Code,I shall l wit mply with those provisions. OYES amounts
Appli ant,_ Date; 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 checkli
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines '
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND AYES �NO
CIVIL FINES UP TO ONE KUNDRED 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 of school?
LABOR CODE,INTEREST,AND ATTORNEYS FEES OYES ,L 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.t understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health Safety e,Section 25605 and 25534 conceming
3097 Civil Code) hazardous mate Ire orti
OWNER BUILDER DECLARATIONS ❑YES 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 PROk-ffr<0AAaC1K 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,alter, 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-Business 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 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 civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit
❑ I, as owner of the property, or my employees with wages as their sole kwww.epa.gov/lead or contact the National Lead Information Center at
600-424-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). 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:
contrectors to construct the prgject'(3ectron 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
..........................,_ ._,:_____,_..., u.........,__,w_____..v__,....a.,.rnn oon..a...i.,....-,Fn..,a,�e 000
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
- Menifee
DATE PERMIT/PLAN CHECK NUMBER - 0
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION C ALTERATION O DEMOUTION O ELECTRICAL XMECHANICAL
O NEW C PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
b'
DESCRIPTION OF WORK 4NhC Cbanm, t7 I
Pk 4- Txv
PROJECTADDRESS �- G� Ple.t k) {3eiaa'
ASSESSOR'S PARCEL NUMBER 33 YO-4-Z OI Z.Z LOT L -'Ll • Aof Ntqqp,�
c Building Dept.
OWNER NAME ' T�r� LI C I'' P
ADDRESS y JUL 2 3 2018
PHONE (/j / / -/�� C-/ EMAIL
Received
APPLICANT NAME (�{ r
ADDRESS //3��cc0,, �/30M UMrr Men I, ��e c� g25S�-F
PHONE (%J! ) q'-7502 EMAILrnonK5alr1D rrvW . Gom
CONTRACTOR'S NAME 1..1 �-I- f 1/I p ,, OWNER BUILDER? OYES NO
BUSINESS NAME o 1 it COndi •fir)
ADDRESS
//F S// >O/� � I'MI�r�I►r-1tln Rd 'I
CA `325
PHONE (NISI) Lp 1`�f 7909— /EMAIL mbnl-S60r aD G )►,a:L.1- • GDm
CONTRACTOR'S STATE/LIC NUMBER `mil f Z 11?L LICENSE CLASSIFICATION C LQ
VALUATION$ -J 0 /. G SQ FT to L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFFUSE ONLY'
DEPARTMENT DISTRIBUTION - CITY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE I AMOUNT PAID AMOUNT ,
O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH 0CHECK# 0CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER 0 YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd, Menifee, CA 92586 951-6:12-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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