PMT14-02069 City of Menifee Permit No.: PMT14-02069
_ 29714 HAUN RD. Type: Residential Mechanical
CEL.A> MENIFEE, CA 92586 1
MENIFEE Date Issued:
08/08/2014
l
1
PERMIT
Site Address: 27716 AVENIDA INTERNO, MENIFEE, CA Parcel Number: 333-274-021 _
92585 Construction Cost: $10,096.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, SPLIT SYSTEM, 5-TON A/C, 100,000 BTU FURNACE
Work:
Owner Contractor
CYNTHIA CALDERON MONK'S AIR CONDITIONING
27716 AVENIDA INTERNO P 0 BOX 128
MENIFEE, CA 92585 SUN CITY, CA 92586
Applicant Phone: 9516794502
GARY MONK License Number: 912194
MONK'S AIR CONDITIONING
PO BOX128
SUN CITY, CA 92586
Fee Description ON AmountAmount($)
Air Handling/Condensing Units SFR 1 133.00
� din" el e Q
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_Bidg_Permit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED NSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the properly an _exclusively contracting with license
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professio
Professions Coed my license is in full rce and effle(. Code:The Contractors License Law does not apply to an owner of a propel
3 F I (�Q_License N 7 who builds or Improves thereon, and who contracts for the projects with
License Class. .-
Explre Signatu '-- licensed contractor(s)pursuant to the Contractors State License Law),
WORKERS'COMPENSATION DECLARATION ❑ I am exempt from Iicensure under the Contractors'State License Law for I
❑ 1 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 370O..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 N
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:hto,/ANww.leginfo.ca.cigmicalaw.html.
permit Is Issued.My workers'compensation Insurance carrier and policy number are:
. y—_+ - roperty wrier or ooze gent - ,Date
Carrier r f (1� �7 -
Expires I —' Policy# I L�D I /- 121
❑ By my Signature below, I certify to each of the following: I am the propi
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read
(This section need not be completed If the permit is for application and the Info on I have provided is correct. I agree to can
one-hundred dollars($100)or less) with all appli ble city a unty ordinances and state laws relating to builr
constmctio . oft presentatives of this city or county to enter the abr
❑ 1 certify that in the.performance of the work for which this,permit is issued,I identified arty f t Ins action purposes.
shall not employ any persons in any manner so as to become subject to the
workers'compensation laws of California, and agree th If I should become -
subject to the workers'compensation pip c of Se n 3700 of the Labor Pro ner- Authorized Agent Date
Code,I shall forthwith comply with those p .�/ ^
_ City Business License# J /
Date; Applic
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 AHAZARDOUS MATERIAL ORy
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 MODIFICATIOI
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 reasons)indicated below by the checkmark(s)I have placed OYES 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 MATERD
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 PERMP 1P
she is exempt from licensure 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($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNIt
HAZARDOUS MATERIAL ifEPORtING.
❑ 1, as owner of the property, or my employees with wages as their sole
compensation,will do( )all of or( )porting of the work,and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not Intended or offered for sale.(Section 7044,Business and Professions Code;
p Fa :y
The Contractor's State License Law does not.apply to an owner of a property X �
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that It was not built or improved for the
purpose of sale).
CITY O M ENIFEE City of Menifee PLCK No: Permit No:
_
29714 Haun Road building & Safety Dep Date: Date,
Menifee, CA 92586 AUG 0 8 2i)14 Amount: Amount:
Phone: (951)672-6777 cn
Fax:(951)679-3843 Received Ck#: Ck#:
Building Combination Permit
To Be Completed By Applicant
Legal Description: ,¢ Planning Case: F: L: Rt: R
Property Address: Assessor's Parcel Number.
oZ �
Project/Tenant Name: Vf Unit#: Floor#:
Cal-Dv'1'La
Name: one—No. ax No.
vvT\45,A GAl ot�'GDo
Property Address:Owner 7�-42
Unit Number Z Code
A_b r4VA��Ofk .a �
Email Address:
Name: lPhone No. ax N
GR2 vY�0V-k�c qv 6'1$I'v1Sb2 qa- (0'77- 2012
Applicant Address: Unit Number Zip Code of zs-�
3 0�3 0 'Mv ma's�'rA t%n C(
Email Address: YV\ovA V_5
�1)
Name: e�No.VA,\^kS SIG 6-)cl, �tSU2 (e°I�'o (p72 -Zo12
Contractor Address: City State Zip Code
-So VV\vfLRJ��'1-fa YI-0 m�` /sF�Fif CAA
contractor's
u-siness License o. Contractor'-2 8 `CVgte of Califomia License No. Classification: �Z u
Number oLA
f Squares:
Square Footage ` wT
Description of Work: L CiFN~be ov f — 5'ev't=r— C : S--O'1v✓t 0-rr. k W 1G'g'7-V Cost of Work:$
Applicant's Signature Date:
Tp Be Completed By'G.ity staff only _
Indicate As R-Received or N/A-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 ElGeo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8'/.x 11)
❑
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan Structural Calculations
❑ Single Line diagram for slat,services over 400 AMP
❑ Floor Plan ❑ Structural Frarning Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration* Addifion' Means/Methods
Work Type: Repair' HRetrofit' Reftntc EAsting Pettnit' Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
at Buildings: #Units: #Stories: Will the Building Have a Basement?
Y of N
Bldg. Code Occupancy Group Indicate Indicate it YES or Ni Indim a all Geo-tech,Haz.Zone
At Project Construction Sprinklered that apply: Coastal Zone
Completion: Type(s): C Of O Noise Zone
Required? YES or NO
Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss JArch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit Spec case:'n g.
Officia$Approval
Expedite Project(s): Child Care City Project Green Building Landmark Afford-able Housing
For Staff Use Only
Building/Safety Permit Specialist Cily Planning I Civil Engineering EPWM-Armin ITransportation Mgmt. I Renl Control
a__ THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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