PMT18-03962 City of Menifee Permit No.: PMT18-03962
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 08/10/2018
PERMIT
Site Address: 27101 SUN CITY BLVD,MENIFEE, CA Parcel Number: 337-252-027
92586 Construction Cost: $2,903.31
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, NEW CARRIER 2.0, 14 SEER R410a SINGLE STAGE CONDENSING UNIT,NO
Work: FURNACE
Owner Contractor
TIM&KRISTINA MILLER MONKS AIR CONDITIONING
27101 SUN CITY BLVD P O BOX 128
MENIFEE,CA 92586 SUN CITY,CA 92586
Applicant Phone:9516794502
TIFFANI SELLERS License Number.912194
MONWS AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description gtv Amount I$
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 carded 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 licensure 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 section 7000)of Division 3 of the Business and By my signature below I acknowledge that,except for my personal residence
Professions Code god�^license is in full force and efr f which I must have resided for at least one year prior to completion
License Class No. Z improvements covered by this permit,I cannot legally sell a structure that I hi
I-0 , SignatuLtcens
Explres3-3 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 application
submitted or at the following Website:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: hltoJMuM1v.leainfo.w.gowcalaw.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 0wner or Authorized Agent
Policy# ❑.By my Signature below, 1 certify to each of the following: I am the propt
( 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 corect I agree to cor
permit is issued.My workers'compensation insurance carder and policy number are: with all applicable city and county ordinances and state laws relating to build
C construction.I authorize representatives of this city or county to enter the abo
Cartier a� J Q identified property for the Inspection purposes.
Policy#12-7b0- !/Z Expires �— I —! / Date
' Properly Owner or Authorized Agent
(This section need no be completed if the permit is for 03540 g
one-hundred dollars($100)or less) City Business Ucense#
14 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 o
wcrkers'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 eclfied on the Hazardous Materials Information Guide?
Code,I shall f cooly with those provisyiyo�n�s. ❑YES 7
Appli n- Date; V 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 checks
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES J<NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the ou
DAMAGES AS PROVIDED FOR iN SECTION 3706 OF THE boundarK of school?
LABOR CODE,INTEREST,AND ATTORNEYS FEES ❑YESNO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirn that under the penalty of perjury there is a construction lending permitting ohecIdist.I understand my requirements under the State of
agency for the performance of the work which this permit is issued(Section Califomia Health$ Safety C e,Section 25505 and 25534 concerning
3097 Ciw7 Code) hazardous mate) I re orti
OWNER BUILDER DECLARATIONS ❑YES NO( DaA-2�1?
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROk-wrr0XVNAa,0AAUTHORIZED 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 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 70D0)of Division 3 of the-136sinpss and Professions Code)or that he or residence or childcare facility to be RRP-certified firths and comply with
she is exempt from.lcensure,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).y employees.For more information about EPA's Renovation Program visit:
ro www.epa.gov/lead or contact the National Lead Information Center at
❑ I, as owner of the property 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 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 Firm is required for this project because:
contactors to construct the prq)eci(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
IT/PLANFETY PERM APPLICATI ON
Menifee
DATE "2—I PERMIT/PLAN CHECK NUMBER1 117a
I-ILY OT IvIeni ee
TYPE: O COMMERCIAL 34 RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA_ t,
SUBTYPE: O ADDITION C ALTERATION O DEMOLITION O ELECTRICAL MECHANICAL;,,
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
%.JJ 7 U 20 8 �
DESCRIPTION OF WORK ftc CbanQe i+]
�� L u
(Q i I roc U �c e -L - iv C `rm?c-
n• r, !1 1 J
PROJECTADDRESS 2-7 1 G Oa- (�j" 1 -1�-% %k o \ Coi' cru W fD
ASSESSOR'S PARCEL NUMBERNUMBER 313?-Z 6 L OZ'3- f_ LOT t`k3 TRACT -6
OWNER NAMEE . I irn cI K . • ! )�� /le Al �P I^,, /' • �y,
ADDRESS •TJ-'�Sl / ` /lf�i.0 f \l ,I:° 1 '-I V�+I 11f . �`7 I,r :Lf� "I.LS l-L
PHONE �IlSI / ll� J- �3�1 EMAIL
APPLICANT NAME � r
ADDRESS 30// Mu--YYr'Tlri•e-Iz,_ d ! M•en fee, c� �25�
PHONE rq�� ) I//P (( -q 502 EMAILYY'1onKSo trOD 9ma:o - Ctrn
CONTRACTOR'S NAME CTarU M or' K OWNER BUILDER? C YES NO
BUSINESS NAME o ! /L'`
�r Condi or"I
ADDRESS
!/' ()5 > M0 r -i�,�r 2d , M-c-n CA
PHONE [ ` ?51J COr7 4,5L 7
_JL EMAIL mon ksa i r c"� rna.�.L • Go m
CONTRACTOR'S STATE LIC NUMBER g121gy LICENSE CLASSIFICATION C2,0
VALUATION$ ,2 , 0ID 5• 3 I SO,FT L SQ FT
APPLICANT'S SIGNA TURE DATE IS 2—
C17YSTAFFUSEOPAY
DEPARTMENT DISTRIBUTION CRYOF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP X
INVOICE ` � M PAIDAMOU
AMOUNT I�+r '' � 1`..Q-j•kp5 OCASH OCHECK# OCREDi7 CARD VISA/MC
PLAN CHECK FEES PAIDA MOUNT OCASH OCHECK# OCRED fCARD 'ASVMC
OWNER BUILDERVERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O /ES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-6.72-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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