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PMT14-02068
e City of Menifee Permit No.: PMT14-02068 29714 HAUN RD. Type: Residential Mechanical p -94GCr-i..A> MENIFEE, CA 92586 MENIFEE Date Issued: 08/08/2014 �{ I PERMIT I Site Address: 28108 NORTHWOOD DR, MENIFEE, CA Parcel Number: 337-161-005 92586 Construction Cost: $6,678.40 Existing Use: Proposed Use: Description of HVAC CHANGE OUT, 40,000 BTU FURNACE, 2.5-TON A/C Work: Owner Contractor DANIEL ALBERT MONKS AIR CONDITIONING 17656 FONTICELLO WAY P 0 BOX 128 SAN DIEGO, CA 92128 SUN CITY, CA 92586 Applicant Phone: 9516794502 GARY MONK License Number: 912194 MONKS AIR CONDITIONING P0 BOX 128 SUN CITY, CA 92586 Fee Description City Amount Fggr a AirtraVlt ";T pe Fur aCe orBuCneY 1 - 49 00 Air Handling/Condensing Units SFR 1 133.00 Su'I ' gRetmi�ls us a ce 27)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 building 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 Men'fee LICENSEE?DECLARATION I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an ;exclusively contracting with licensi I Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professio Professions Cc��t d my license is in full rce and effle Code:The Contractor's License Law does not apply to an owner of a propel I License Class. ,120—License N 4`7 _ _ _ who builds or Improves thereon, and who contracts for the projects with 11 Explre3-3 F I rd :Slgnatu licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARATION ❑ I am exempt from licensure under the Contractors'.State License Law for 1 ll ❑ I hereby affirm under penalty of perjury one of the following declarations: following reason: I have and will maintain a certificate of consent of seiNnsure 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 covered 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 Ilceru Policy# contractors. I understand that a copy of the applicable law, Section 7044 of ❑ I have and will maintain workers' compensation Insurance, as required by Business and,Professions Code,is available upon request when this applicatloi section 3700 of the.Labor Code, for the performance of the work for which this submitted or at the following Web site:Lttg'/Lwww lealnfo ce eovlcelaw htmi. permit Is issued.My workers'compensation insurance carrier and policy number are: f-9 _ Property wneror uthonze Agent Data (1� �7 _ Expires �' Policy# 1 2,J w 1/' 7� ❑ By my Signature below, I certify to each of the following: I am the prop Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read (This section need R2 be completed 0 the permit is for application and the Info on I have-provided is correct. I agree to con one-hundred dollars($100)or less) Z a unTy ordinances and state laws relating to built z rpresentatives of this city or county to enter the abc ❑ 1 certify that in the.perfornance of the work for which this permit is issued,I t inspection purposes. shall not employ any persons in any manner so as to become subject to the workers'compensation laws of California, and agree th ifI should become subject to the workers'compensation provisio cf Se n 3700 of the Labor uthorized Agent Date Code,I shall forthwith comply with those proyi city Business License# Date; Applic 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 BUILDING ($100,000), IN ADDITION TO THE COST OF,COMPENSATION, ❑YES 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 - ❑NO 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 ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATI01 FROM THE SOUTH COAST AIR QUALITY MANAGEMEN' Lender's Address ❑NO 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 []YES WILL THE PROPOSED BUILDING OR MODIFIED FACILIT next to the applicable item(s)(Section 7031.5. 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, ❑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 []YES INFORMATION GUIDE AND THE SCAQMD PERMITTIP she Is exempt from licensure and the basis for-the alleged exemption. Any CHECKLIST. 1 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 clvil penalty of not more than($500).) CODE. SECTION 2OUS 605tfE5533 GD 25534 CONCERN11 HAZAR❑ I, POikf 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; <7- X a, ' 8 $$ .x.. ; The Contractor's State License Law does not apply to an owner of a property -- who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, 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 ME IFEE PLCK No: Permit No: 29714 Haun Road City of Menifee Date: Date: Building & Safety Dept Menifee, CA 92586 8 1.3 1 Phone: (951)672-6777 AUG 0 8 2014 Amo fib `�o 3 0"� Fax:(951)679-3843 Ck#: Ck#: Received Building Combination Permit To Be Completed By Applicant Legal Description: +- -5 6 Planning Case: F: L: Rt: R Property Address: V Assessor's Parcel Number. w v1��wv�o d�t2 1 —o o !�— ProjecVrenant Name: \5l Unit#: Floor#: Name: DvYlr\ ��` - hone Fax No. Property Address: O� b q 3 Owner - Unit Number Zip Code Email Address: Name: hon No. axN (7�� YndnK -01 67%-MSb2 asl b-12 2a12 Applicant Address: 305-30 Unit Number Z'ry Code Email—Address: �� Name: Phonq No. �1'C15b2 No Contractor Address: City State Zip Code 3a�3� vv�., r �na n-O m CAA gzsk N( Contractor'3S a."ss License No. Contractq`CZryt qte of California License No. Classification:Uk ��V Number of Squares: Square Footage k-13 Description of Work: W CAA3KT: u10"-TV �, C. Z S'J'ovt Cost of Work:$ �b.��, �O Applicant's Signature Date: -. �To Be Completed By City Staff Only - Indicate As R-Received cr N/A-Not Applicable 5 Completes sets of fully dimensioned,drawn to sale plans which include: t set of documents which include ❑ Ttle Sheet ❑ Elevations ❑ Electrical Plan ❑ Gad Tech/Soils Report(on cd only) ❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8%x 11) ❑ Foundation Plan ❑ Structural Calculations ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for also.services over 400 AMP ❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential Class Code: Indicate New Construction Alteration' Addition" Means/Methods Work Type: Repair* Retrofit• Revision to Fxdsting Permit' Required? YES NO Proposed Building Use(s): Existing Building Use(s): #Buildings: #Units: #Stories: Will the Building Have a Basement? Y of N Bldg.Code Occupancy Group Indicate Indicate if YES or NO Indicate all Geo-tech.Haz.Zone At Project Construction Sprinklered that apply: Coastal Zone Completion: Type(s): C Of 0 Noise Zone Required? YES of NO Listed on Historic Resources Inventory CITY PLANNING STAFF ONLY APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. I Planning Comm.Zoning Administrator Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit special case:Bldg. Official roval Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing For Staff Use Only Building/Safety Permit Specialist City Planning Civil Engineering EPWM-Admin Transportation Mgmt. Rent Control ��-2- Y T THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY D w n mV t�Jl w O T D 9 D m m v 2 d. m In n (] N n 9 3 D J P. .di r a N o m 3 d o o D z ' y j Z C r m O On On _ » ^ d m O d n J J 3 m m < .. 3 m a 3 3 N !� 2 N J m O O °<° Oy. 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