PMT18-04007 City of Menifee Permit No.: PMT18-04007
29714 HAUN RD.
rhr MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 08/1412018
PERMIT
Site Address: 28593 PIPING ROCK RD, MENIFEE, CA Parcel Number: 336-061-005
92586 Construction Cost: $6.760.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, NEW CARRIER 2.0 TON 14 SEER SINGLE STAGE R41Da SPLIT AfC WITH
Work: 70,000 BTU FURNACE
Owner Contractor
VICKIE VAN EARNERT MONK'S AIR CONDITIONING
28593 PIPING ROCK ROAD 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(SI
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 Code or of any other
ordinance of City of Menifee.Except as otherwise staled,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 fiicensure 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�WW license is in full force and eff t which I must have resided for at least one year prior to completion
License Class l,�_Ucens No. )2-/QL1 improvements covered by this permit.I cannot legally sell a structure that I he
Expires3-31- 2.0 Signatu 4xf
built as an owner-building if it has not been constructed In its entirety by licens
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: httpJMw .leginfo.m.gov/mlaw.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
V I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owners behalf. 1 have read ti
section 3700 of the Labor Cade, 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.Mywodkers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to buildi
C� construction.I authorize representatives of this city or county to enter the abok
Carrier ti idenfied property for the inspection purposes.
Policy#/ G' 700— I Z Expires y Q — Date
Property Owner or Authorized Agent
(one-hundred dollars($100)or less)This section need not be completed if the permit is for 035lA78
City 8usfness License#
1 certify that in the performance or 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 ecifieof on the Hazardous Materials Information Guide?
Code,I shall f wit mply with those provisions. ❑YES N0
Appli anY Date; Lr . 1. 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 DYES }(NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000),IN ADDITION TO THE COST OF COMPENSATION, Nil the proposed building or modified facility be within 1000 feet of the out
DAMAGES AS PROVIDED FOR iN SECTION 3706 OF THE bounds of a school?
LABOR CODE,INTEREST,AND ATTORNEYS FEES ❑YES JVNO
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
Safety C e,Section 25505 and 25534 concerning
3097 Civil Code) hazardIre orliOWNER BUILDER DECLARATIONS ❑YES
1,4
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 chedkmark(s)I have placed PRO O N PKAUTHORiZED 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 fRRP)
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 Ucense Law(Chapter 9(commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the-Businass 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 703:1.5 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($500).) employees.For more information about EPA's Renovation Program visit:
❑ I, as owner of the roe or m ern to sets with we es as their sole �'epa.gov/lead or contact the National Lead Information Center at
compensation,will do(p)all of or( )porting of the work, and the structure is 1-BOO-024-LEAD(5323).
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 Finn Certification No.:
purpose of sale).
❑ 1, 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 prpiecC(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
v______ .._.._. ...... me oon..d...d.......fu...n,k..o00
SAFETYa APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION C ALTERATION O DEMOLITION O ELECTRICAL kMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK bull
1 V Lo-L(J LLL-i Z-U'-I-Z7l'l
6 S Sd��� �S � f2 . D� � c i w -7v 13w
PROJECTADDRESS 2 I K )C.L� CI ( . �l.-P Cry �f2 2 ,
ASSESSOR'S PARCEL NUMBER UO'�'h' LOT I L) TRACT
City Of Menifee
OWNER NAME
\J �CL .el
ADDRESS I � C � . 4 5C ") !�1 (67 L
PHONE 6?1 U) ZZ }- 14 y—j EMAIL AIJU 4 2018
APPLICANT NAME I/ r
ADDRESS //3�� 0\53v M� U�Yr)r M en i [ems
PHONE (`7J1 J ��/I?—Lf S` D2 /� EMAILrnot1KS0 Irk wvCLJ , Can
CONTRACTOR'S NAME l..{ A-ry / y 1 QrL K, OWNER BUILDER? C YES NO
BUSINESS NAME C Mnnl�,� I r Cond i 'b n I
ADDRESS n / S ( GA /G.S
PHONE (q5/� 69-76:�- 4,4502- EMAIL monk-Salr rD G1eyta.L.L . Gom
CONTRACTOR'S STATE LIC NUMBER �12�qy LICENSE CLASSIFICATION C2.0
VALUATION SC,Fi tj L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFFUSEOPILY
DEPARTMENT D1511RIBLmON k 11710E MENIFEE MSINE55 LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ' SMIP
INVOICE PAID AMOUNT 2
AMOUNT - Q V��' 1b OCASH O CHECK# OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDA MOUNT 0CASH 0 CHECK# OCREvrCARD VWmc
OWNER BUILDER VERIFIED OYES 0 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.citycfinenifee.us Inspection Request Line 951-246-6213
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