PMT18-03967 City of Menifee Permit No.: PMT18-03967
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 0811012018
PERMIT
Site Address: 30491 NAPA ST, MENIFEE, CA 92584 Parcel Number: 360-472-012
Construction Cost: $4,483.31
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, NEW CARRIER 4.0 TON, 14 SEER R410a SINGLE STAGE A/C
Work:
Owner Contractor
MICHAEL JACOBSON MONKS AIR CONDITIONING
30491 NAPA STREET P 0 BOX 128
MENIFEE,CA 92584 SUN CITY, CA 92586
Applicant Phone:9516794502
TIFFANI SELLERS License Number..912194
MONKS AIR CONDITIONING
PO BOX128
SUN CITY, CA 92586
Fee Description OQrt Amount($1
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 he
forfeited.
AA_Bldg_Pennit_Template.rpl Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from Iicensure 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
Professions Code license Is in full force and eft t which I must have resided for at least one year prior to completion
License Class ZT No. 2-1 improvements covered by this permit,I cannot legally sell a structure that I ha
Expires3-3I-�V . SignatuLicens built as an owner-building If it has not been constructed in its entirety by Iicens
contractors.I 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: httpJAvww.leginfo.m.gov/mlaw.htmi.
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 props
)5( 1 have and will maintain workers compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read 11
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.Myworkers'oompensation insurance carder and policy number are: with all applicable city and county ordinances and state laws relating to bulldi
construction.I authorize representatives of this city,or county to enter the abor
Carrier SC-4 IF= Q identified property for the inspection purposes.
Policy#12-700- /Z Expires U L� Date
Property Owner or Authorized Agent 22�j
(This section need not be completed If the permit is for City Business License# O J ✓�7�
one-hundred dollars($100)or less)
4I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or
workers'compensation laws of California,and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts s ecified on the Hazardous Materials Information Guide?
Code,I shall f hwit mply with those provisions- / ❑YES 70
App1f 01. Date; U ` Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checkii
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines '
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES J<NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($I00,0D0), IN ADDITION TO THE COST OF COMPENSATION, WIII 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 NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby aflirn 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 A Safety C9 e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous maleyl Ire orti
OWNER BUILDER DECLARATIONS DYE S N0� '0//
I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's Date I
License Law for the reasori(s)indicated below by the checkmark(s)I have placed PRO OAk.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 censtruct,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-Busingss and Professions Code)or that he or residence or childcare facility to be RRP-certified firms 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 a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than(S500j.) employees.For more Information about EPA's Renovation Program visit
❑ I, as owner of the roe or ,n employees with wa es as their sole www.epa.govhead or contact the National Lead Information Center at
property,rty, Y9 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.(Swgon 7044,Business and Professions Code;
The Contractors State License Law does not apply to an owner of a properly ❑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 Finn 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 Firm Certification No.:
purpose of sale).
❑ 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 projech(Secbon 7044,Business and Professions
Code:The Contractors License Law does not apply td an owner of a property
who builds or Improves thereon, and who contracts for the projects with a
n......-. r:n..,.,.r..DOo
BUILDING & SAFETY PERMIT/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 ADDMON O ALTERATION O DEMOLITION O ELECTRICAL XMECHANICAL
O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK hC 1NI t4J l.. Y ,G V-U�
jam ,U 50�w lO S /lam jSf�� C_ h
PROJECT ADDRESS -30 !�! j�1 Sl , �1�� �4�" C/� L
ASSESSOR'S PARCEL NUMBER I -1 LOT 575 TRA'Y' r m 2
OWNERNAME
ADDRESS /� // nnp !! GC�I=Z
PHONE (G1�1 )7GV U-l�il"��G EMAIL Raceived
APPLICANTNAME (..� �rU
ADDRESS
3�530 ru rile-Ivy V,d, MtriI �ef CA C-I25R
PHONE rg51 J (.:!/9-'f5M EMAILrnonKSalrfDgrnct 4 . Urn
CONTRACTOR'S NAME l�I �-ry / y1 QnK OWNER BUILDER? O YES NO
BUSINESS NAME
I i t Conch i '�n I
ADDRESS /�y.( JS 0 Mj )r�Iri� Ed , Mmi ca II 4
PHONE ('mil Sf� Cplq— 4 02- l EMAIL monlcScilr r'J h'1.�L.�. cz,YYI
CONTRACTOR'S STATE
//LICNUMBER `�112 (I?L( LICENSE CLASSIFICATION CZ-Q
VALUATION$ 4, Y 7^ I SO FT 2C7O LSQ FT
APPLICANT'S SIGNATURE DATE
,CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINES:UCENSE NUMBER
BUILDING PLANNING E k
AMOUNT ENGINEERING FIRE GREEN SMIP v -V5 I
PAID AMOUNT ,mac
O CASH OCHECK# O CRIED'i CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# 0 CRED!T CARD VISAIMC
OWNER BUILDERVERIFIED DYES O NO DL NUMBER NOTARIZED LETTER O YES 0 NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-6:2-6777
www.cityofinenifee.us Inspection Request Line 951-246-5213
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