PMT14-02062 City of Menifee Permit No.: PMT14-02062
� 29714 HAUN RD. Type: Residential Mechanical
�E1- MENIFEE, CA 92586
cPfAp""Wk., MENIFEE Date Issued: 0 810 8/2 01 4
i
PERMIT
i
Site Address: 28757 PEBBLE BEACH DR, MENIFEE, Parcel Number: 337-221-015
CA 92586 Construction Cost: $5,800.00 '
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT SPLIT SYSTEM, 3-TON A/C, 70,000 BTU FURNACE
Work:
Owner Contractor
JANICE TUSKEWICZ MONKS AIR CONDITIONING
28757 PEBBLE BEACH DRIVE P O BOX 128
MENIFEE, CA 92586 SUN CITY, CA 92586
Applicant Phone: 9516794502
GARY MONK License Number: 912194
MONKS AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description ON Amount 1$)
Air Handling/Condensing Units SFR - 1 133`00
GREEN FEE 1 1.00
$310.00
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_Bldg_Permit_Template.rpt Page 1 of 1
City Of Menefee
LICENSED DECLARATION
1 hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an _exclusively contracting with license 11
Chapter 9(commencing with sec0on 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professio
Professions Co d my license is in full force and effle(. Code:The Contractor's License Law does not apply to an owner of a prope
License Classf.Z License N `i - _ .. who builds or improves thereon, and who contracts for the projects with
Expire Signatur licensed oontractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION ❑ lam exempt from Iicensure under the Contractors'State License Law for I
❑ I hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of self-Insure for workers' By my signature below I acknowledge that, except,for my personal residence
compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion
Section 3700..of the Labor Code, for the performance of work for which this 'improvements coveted by this permit,I cannot legally sell a structure that I hi
permit Is Issued. built as an owner-building If it has not been constructed In its entirety by liceni
Policy# contractors. I understand that a copy of the applicable law,.Section 7044 of
❑ 1 have and will maintain workers' compensation Insurance, as required by Business and,Professions Code,is available upon request when this appllcatioi
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http•/h"Ieclnfo ca calaw html.
permit Is issued,My workers'compensation Insurance carrier and policy number are: - -
fir- �-* roperty wneror. u ooze gent - ,Date
Carrier f"
Expires rl Policy
❑ By my Signature below, I certify to each of the following: I am the-props
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read
(This section need 0Q be completed If the permit is for application and the Info on I have providedis correct. I agree to con
one-hundred dollars($100)or less) with all appli ble city a ounty,ordinances and state laws relating to bulk
constructlo . oriz r presentatives of this city or county to enter the abc
❑ 1 certify that in the.performance of the work for which this,permit is Issued,I identified arty Ins ection purposes.
shall not employ any persons in any manner so as to become subject to the -
workers'compensation laws of Califomia, and agree th if 1 should become -
subject to the workers'compensation provisio of Se n 3700 of the Labor Pro ner Authorized Agent Date
Code,I shall forthwith comply with those pro
- _ City Business License
Date; Appfic t; - -
WARNING: FAILURE TO - SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL -
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDINC
($100,000), IN ADDITION TO THE COST.OF.COMPENSATION, OYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR
DAMAGES AS PROVIDED FOR IN SECTION`3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAI -
LABOR CODE, INTEREST,AND ATTORNEYS FEES ONO EQUAL TO OR GREATER THAN THE AMOUNT,'
CONSTRUCTION LENDING AGENCY SPECIFIED ON .THE HAZARDOUS MATERIAL:
INFORMATION GUIDE?
I hereby affirm that under the penalty of perjury there is a construction lending
"
agency for the performance of the work which this permit is Issued (Section WILL THE INTENDED USE OF THE BUILDING BY THI
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRI
Lender's Name OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATIOI
FROM THE SOUTH COAST AIR QUALITY MANAGEMEN'
Lender's Address ONO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOI
GUIDE LINES
OWNER BUILDER DECLARATIONS PRINT NAME:
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 OYES WILL THE PROPOSED BUILDING OR MODIFIED FACIL17
next to the applicable item(s)(Section 7031.6.Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF
Any city or county that requires a permit to construct, alter, improve, demolish, 0 NO SCHOOL?
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 I HAVE READ THE HAZARDOUS MATERN
provisions of the Contractor's State License Law(Chapter 9 (commencing with
Section 7000)of Division 3 of the Business and Professions Code)or that he or OYES INFORMATION GUIDE AND THE SCAQMD PERMITTIP
she is exempt from Iicensure and the basis for.the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMEN'
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFE'
a civil penalty of not more than($500).) CODE, SECTION 25505RIALRE5533 G D 25534 CONCERN It
HAZARDOUS❑ POkt
1, as owner of the property, or my employees with wages as their sole
compensation,will do( )all of or( )porting of the work,and the structure Is PROPERTY OWNER OR AUTHORIZED AGENT
not Intended or offered for sale.(Section 7044,Business and Professions Code;
Qp qt $. ha a's
The Contractor's State License law does not apply to an owner of a property X _ — �-----
who, through employees' or personal effort, builds or improves the property, °
provided that the Improvements are not intended or offered for sale.If,however, r `=
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).
CITY OF MENIFEE City of Menifee PLCKNo: Permit No:
Building & Safety Dep . a
29714 Haun Road Date: Date:
Menifee, CA 92586 AUG 0 8 2014 %H
Phone: (951)672-6777 Amount ount
Fax:(951)679-3843 Received Ck#: ck p
Building Combination Permit
To Be eted By Applicant
Legal Description: TR Z-k"O L C)T— Z 3 cl Planning Case: F: L: Rt: R
Property Address:
Assessors Parcel Number 3 Z Z) O`J
ProjecuTenant Name: W 2,
s Unit#: Floor#:
JS�cI
Name: J�A�,ASw5 CZ sWT` ton Fax No.
Property Address: ter ti —S"1'-1
Owner Z 7 j 7 P\�V,� 13\yyk�.kL -012 Unit t Number lip Code c{2 S�C�
Email Address:
Name:
GAR yYlatl��G qst 67�-H�2 qsNl b72-2a12
Applicant Address: Unit Number
3oi 3o M�`(L`R�b`TA �D Zip Code g2'SSrL(
Email Address:
V�=1p� vL VN1Ccl.C.ovr
Name:
Vho��s AIG as�blq^�tSb2 M�\) W72-Zo12-
contreclor Address: 30 5-30 VVNv Y1-0 City state Zip Code
m\Fv�.FLj (�1A 017,s1-%J
o ctor s u3 Hess ILICOnSe No. ContracM�r'`C2 qte of California License No. Classification: �Z V
Number of Squares:
Square Footage
Description of Work: ttV(V— C\LA.A C t£ -0vr —Sy;L$Jr_ )l C: s�vCost of Work:$
App Icanfs Signature
Dew. Li
lndcate As R-Received or NIA-Not Applicable
5 Completes sets of fully dimensioned,drawn to sale plans which include: 1 set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Gad TecWsolls Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(onl
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Structural Calculations
❑ Single Line diagram for also.services over 400 AMP
❑ Floor Plan ❑ Shiclural Freeing plat&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addlla• Means Mel ods
Work Type. R r. Retrofit' Add"ll is Et6sting Paml' Requbed? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have a Basement?
Bldg. Code Occupancy GroupY of N
r p y Indicate Indurated Indicate all Geo-tech.Haz.Zone
At Completion:
Spdnklered YES or NO
Completion: Construction That apply: Coastal Zone
Type(s): C Of D YES or NO Norse Zone
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. IftanningComm Zoning Administrator
Fee Exempt: City Project Elec.Vehide Charger Landmark Seismic Retrofit ass: g
offidal meal
Expedite Project(sy Child Care city Project Green Building I Landmarl I Affordable Housing
For Staff Use Only
Building/Safe Buliding/Safety I Permit Speciellst I City Planning Civil E imenng EPMI-Acnoln Trensporumon mt. Reel Control
�— I THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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