PMT14-02072 City of Menifee Permit No.: PMT14-02072
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Mechanical j
MENIFEE Date Issued: 08/08/2014 i
i
PERMIT !
1
Site Address: 29238 PEBBLE BEACH DR, MENIFEE, Parcel Number: 338-083-004
CA 92584
Construction Cost: $5,278.40
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, SPLIT SYSTEM, 2.5-TON A/C, 70,000 BTU FURNACE
Work:
Owner Contractor
MATT NELSON MONKS AIR CONDITIONING
27225 AVENIDA DEL DIABLO P 0 BOX 128
TEMECULA, CA 92590 SUN CITY, CA 92586
Applicant Phone: 9516794502
GARY MONK License Number: 912194
MONKS AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description ON Amount 1$)
Air Handling/Condensing Units SFR 1 133.00
p
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
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City Of Menifee
LICENSED DECLARATION
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I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property 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 Cod- d my license is In full rce and effecft. Code:The Contractor's License Law does not apply to an owner of a prope
License Class l-. Q_License N "! - _ .. who builds or Improves thereon, and who contracts for the projects with
Expiret3 a F L16 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
❑ 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 37g0.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-bulls ing If it has not 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 appllcatloi
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the followingWeb site:bttp,IMMw le ing_fo ca aov/calaw html.
permit Is issued.My workers'compensation Insurance carrier and policy number are:
.fir /^+ _ rope wnerocAuthonze Agent - - Data
Cartier -5 t� _ ll /�(1� q -
Expires8-1 1 policy# I�� /lt/ �' `/i
❑ 8y 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 OQ be completed If the permit is for application and the Info 'on I have provided is correct. I agree to con
one-hundred dollars($100)or less) with all affertyinspecfion
ounty ordinances and state laws relating to built
construdesentatives 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 purposes.
shall not employ any persons in any manner so as to become subject to the
workers'compensation laws of California, and agreeth if I should become
Subject to the workers'compensation provisio of Se n 3700 of the Labor Pro ed Agent Date
Code,I shall forthwith comply with those pro ' ors.
_ City Business License# 3 /
Date; .',caplet 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 F
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 OYES 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 reason(s)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 MATERI/
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 PERMITTIl'
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
S ION 25505RIALR25533'W AND 25534 CONCERW
HAZAND❑ I, 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; -�
X .I. a Fr..:q
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 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 `• ENIFEE City of Menifee PLCK No: Permit No:
--cgu
29714 Haun Road Building & safety De `Date: Date:
Menifee, CA 92586 $1
AUG 0 8 2014
Phone: (951)672-6777 Amount: Amount:
Fax:(951)679-3843 ,.y�
RecoeivPiLR� Ck#: k#:
Building Combination Permit
To Be Completed By Applicant
Legal Description: ,TyZ Z�� - ` b ,� Planning Case: F: L: Rt: R
Property Address: Assessor's Parcel Number:
PoF3o0\A
Project/Tenant Name: Unit#: Floor#:
Name: VV\,,-�T- �� D V1 honMZ_ �/�alFax No.
�IuPulOwner Address: Zr7 y z� AVM \o Unit Number Zip Code q -z �� D
Email Address: - -ee CLA Q
Name: (7� V`(�O�k k No. axN
o1s� 6 )%'`1Sb2 at�l (0 12 2012
Applicant Address: Unit Number Zip Code
Sasso rnv�(t1�,s��A t'un q�zsx-c(
Email Address: ��� _��
Name: J .I e
mvV045 YNl0 q� N.-%ci1-tg52 b (cl!5T) (p'-?2-Zo)2
Contractor Address: city o Stag I Zip Codeg2,_,
ontractor 3 Ity6 a mess tense o. Contractor';try`State of California License No. Classification: �z V
Number of Squares: �"
Square Footage O q
Description of Work: \JV,,L C!LlA�n6tf O�rIG= Z7'N✓1 1>t-T 1u L13�v cost of work:$
�Z7 �'Hl7
Applicant's Signature Date:
-;;; ,.:;ToiBe,Completed By Clty Staff Only - '-
Indicate As R-Received or N/A-Not Applicable
5 Completes sets of fully dimensioned,drown to sale plans which include: 1 set of documents which include
❑ Ttle Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(an 81A x 11)
❑ Foundation Plan ❑ Structural Calculations
❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for also.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan 8 Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration* Addition" MeanslMethods
Work Type: Repair" Retrofit* Revision to Existing Perff tt 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 o Noise Zone
Required? YES O<NO
Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board I I Landmark Comm. I Planning Comm.Zoning Administrator
Fee Exempt: City Project I Elec.Vehicle Chargerl I Landmark Seismic Retrofit I Special case:el g.
Official Approval
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Building/Safety I Permit Specialist I City Planning ICivil Engineering EPWM-Admin I Transportation Mgmt. I Rent Control
12— 1 THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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