PMT14-02071 City of Menifee Permit No.: PMT14-02071
29714 HAUN RD. Type: Residential Mechanical
4..A.' MENIFEE, CA 92586
sm�,. srn`n�Q MENIFEE Date Issued: 08/08/2014 {
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i
PERMIT
Site Address: 27097 SUN CITY BLVD, MENIFEE, CA Parcel Number: 337-252-016
92586 Construction Cost: $5,614.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, SPLIT SYSTEM, 2.5-TON A/C, 70,000 BTU FURNACE
Work:
Owner Contractor
ROBERT RIFE MONK'S AIR CONDITIONING
26471 JAMESTOWN DRIVE P 0 BOX 128
MENIFEE, CA 92586 SUN CITY, CA 92586
Applicant Phone: 9516794502
GARY MONK License Number: 912194
MONKS AIR CONDITIONING
P 0 BOX 128
SUN CITY, CA 92586
Fee Description Oft Amount f$1
Air Handling/Condensing Units SFR 1 133.00
UII IlI -P' Y01 °Isst 'rt. '"' -.'OQ.�
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
f
City Of Menifee
LICENSED 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 lI
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professio I
Professions Co��(rd my license is In full rce and effle . Code:The Contractor's License Law does not apply to an owner of a propel 1
License Class_ __,_�.—License N ) who builds or Improves thereon, and who contracts for the projects with
Explrer. ..-3 E 11 Signatur licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ 1 am 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: -
1 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 Cade,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 d It hasnot been constructed In its entirety by licen:
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 applicatloi '..
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:j>Stg'//www Ieoinfo ca eov/calaw htm1.
permit Is Issued.My workers'compensation insurance carrier and policy number are:
/^± Property Owner orAuthorized Agent - - ,Date
�'
Expires Policy
❑ 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 trot be completed If the permit is for application and the Info Ion I have providedis correct. I agree to con
one-hundred dollars($100)or less) ZlEderty
a ounty ordinances and state laws relating to buik
z 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 t inspection 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 I should becomesubject to the workers'compensation provisio of Se n 3700 of the Labor uthorized Agent - Date
Code,I shall forthwith comply with those proyi ons.
City Business License# 3
Date; Appli 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 AHAZARDOUS 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 THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRI
Lender's Name []YES A PERMIT FOR THE CONSTRUCTION ORMODIFICATIOI
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 FACIL17
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 MATERI/
provisions of the Contractor's State License Law (Chapter 9 (commencing with []YES INFORMATION GUIDE AND THE SCAQMD PERMITTIP
Section 7000)of Division 3 of the Business and Professions Code or that he or
she is exempt from Iicensure 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 civil penalty of not more than($500).) CODE SECTION
E S ION 25505RIALffE5533POkt AND 25534 CONCERNIf
HAZA9DO❑ 1, as owner of the property, or my employees with wages as their sole
compensation,will do( )all of or( )porting of the work,and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not Intended or offered for sale.(Section 7044,Business and Professions Code; <-,
;
The Contractor's State License Law does not apply to an owner of a property X '
who, through employees' or personal effort, builds or improves the property, . � t";,0
provided that the improvements are not intended or offered for sale.If,however,
the building or Improvement is sold within one year of completion,the Owner- -
Bullder will have the burden of proving that 1t was not built or improved for the
purpose of sale).
CITY OF "' E IFEE PLCK No: Permit No:
City of Menifee
29714 Haun Road
Building & Safety Dept. Date: Date:
Menifee, CA 92586 �1
Phone: (951)672-6777 AUG 0 8 2014 Amount: Amounf:
Fax:(951)679-3843 31��
Ck#: Ck#:
Received
Building Combination Permit
To Be Completed By Applicant
Legal Description: T L 7_l$:�— U4:,_% 13 + Planning Case: F: L: Rt: R
Property Address: Assessor's Parcel Number.
Zit Sinn 5� 33 yS2 —olb
ProjecttTenant Name: S G Unit#: Floor#:
Name: qo g�,'12 �i�F G [ S\ (�'�'`G—(a-b(, I
Fax No.
Property Address:
Owner Zb vl �1p.,y,/�, 'Tov..vl ;� Unit Number Zip Code
Email Address:
Name: ho . ax N
Coto¢ vY�o✓�1c qs� No67%-"1Sb2 qsl 672 2aI2
Applicant Address: Unit Number Zip Code
3o>3D Yv�vs�rA Zfl �(
Email Address:
V"+'�tlL��1yV��IGI.f.otM
Lae Phone No. e
lmcov-S � iL c1 1,N1�'1�1"t'15b2 Cea.Nt5e0672-ZoI2.
Contractor ,3� � Vh" Y� Ciry State Zip Code
mN�vNsF-fV CAA 612sK"(or s ny Business tense o. Contractor's City State of California License No. Classification:
3S6 ��2\q �2u
Number of Squares:
Square Footage -:,2
Description of Work: � C U4-✓-O W ovr S�2vr t&, C- Z S \yAFVa-r: 7v k¢n, Cost of work:8 ,b 1 • u o
Appllcant's Signature Date:
To Be Completed ByCity 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 [IGeo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 14 x 11)
[I Structural Calculations
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan [I Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' AddiBon' Means/Methods
Work Type: Repair- Retrofit' RevisiontoFxistlngPerW 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 Indicate all Geo-tech.Haz.Zone
At Project Construction Sprinklered thaYES or NOt apply: Coastal Zone
Completion:
Type(s): C OF O YES or NO Noise Zone
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt City Project Elea Vehicle Charger Landmark Seismic Retrofitl Special case:Bldg.
ORdaIA 'oval
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
BuildinS/Salety Permit Specialist City Planning I Civil Engineering EPWM-Admin I Transportation Mgt. I Renl Control
(Z - Z A- THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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