PMT14-02073 f
City of Menifee Permit No.: PMT14-02073
_ 29714 HAUN RD. Type: Residential Mechanical
GG�.-A MENIFEE, CA 92586
MENIFEE Date Issued: 08/08/2014
PERMIT
Site Address: 26728 CALLE GREGORIO, MENIFEE, CA Parcel Number: 330-291-006
92585 Construction Cost: $5,050.40
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, SPLIT SYSTEM, 3-TON A/C,70,000 BTU FURNACE
Work:
Owner Contractor
MARY JANE MEGGINSON MONKS AIR CONDITIONING
26728 CALLE GREGORIO P O BOX 128
MENIFEE, CA 92585 SUN CITY, CA 92586
Applicant Phone: 9516794502
GARY MONK License Number: 912194
MONKS AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description,. (3yl Amount($)
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
i
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
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professo,
Professions Cof�¢�pd my license is In full rce and effle(. Code:The Contractors License Law does not apply to an owner of a proper,
License Class 4.r'LQ_Llcense N ) `7 . - _ who builds or Improves thereon, and who contracts for the projects with
Expire3-3" _Signatur licensed contractor(s)pursuant to the Contractors State License Law), 1,
WORKERS'COMPENSATION DECLARATION ❑ I am exempt from licensure under the Contractors'State License Law for i
❑ I hereby affirm under penally of perjury one of the following declarations:
following reason:
I have and will maintain a certificate of consent of s -in ure 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 N
permit is Issued. built as an owner-building If It has not been constructed In its entirety by licem
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 applicatioi
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto•/Avww leolnfo ca oov/calaw html.
permit is issued.My workers'compensatlon insurance carder and policy number are:
r^+ - Property Owner or uthonze Agent - ,Date
Carrier f /�(W� �/
Expires ~I Policy# J 2- / 1 2— `/i
in 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 no 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 dty a ounty ordinances and state laws relating to bulk
constmctio on r presentafives of this city or county to enter the abc
❑ I certify that in the.performance of the work for which this,permit is Issued,I Identified erty f inspection purposes.
shall not employ any persons In any manner so as to become subject to the
workers' compensation laws of CaItTomla, and agree th if I should become
subject to the workers'compensaton provisio of Se ' n 3700 of the Labor Pro nor Authorized Agent Date
Code,1 shall forthwith comply with those pro ' c
- City Business License#� Lp
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, 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 ❑NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOI
GUIDE LINES
OWNER BUILDER DECLARATIONS PRINTNAME:
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, after, improve, demolish, ❑NO SCHOOL?
or repair any structure, poor 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 OYES 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. 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
C MATERIAL 25533ftEPOkt AND 25534 CONCERNII
HAZARDO❑ 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; <77-
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 ME IFEE PLCK No: Permit No:
City Of Menifee - 7�)
29714 Haun Road Building & Safety Dept. Date: Date:
Menifee, CA 92586 : !t-t
Phone: (951)672-6777 AUG 0 8 P0N Amount: Amount:
Fax:(951)679-3843 Ck#: Ck#:
Recei ✓ea
Building Combination Permit
To Be Completed By Applicant
Legal Description: T-z Z Uzi T- 17/ Planning Case: F: L: Rt: R:
Property Address: Assessor's Parcel Number:
zG 2f� w�� 4�on,� 33o -76Al — oo�
Project/Tenant Name: Unit#: Floor#:
lM try 6 T�/V.S�V)
Name: hone Fax No.
Owner
Propety Address: Z� 2 V Unit Number Zip Code ZS�
Email Address:
Name: &%0r e 0Y o✓�k J.Phone No. ax N
asp 61°l-M5b2 qa l fo')2-2012
Applicant Address: Unit Number Zip Code
30�3O Vv�v�(Lyt,s1�'rA U'9 0,25Trt-(
Email Address:
YV�u1/V�J l4z'GL 'e- 1M'tnLl.{Ov�^
Name: �,�
VAo0 G 5 S IC \a-b 6nci,-wX7- eq.�\� l�'72-Ztol2
Contractor Address: 30 S-1-0 City c State Zip Code
vV�v 'rfa h%o m\,v1��ft. Gva qzs-k�
Contractor 3 tk6,sVness License No. Contract2k`Cp gte of California License No. Classification: 6�Z u
Number of Squares:
Square Footage j 2 3
Description of Work: _Q $(��'r- I G, 3 N \- Cost of Work:$
}0 1c i3 Tv (�
Applicant's Signature Date:
--Tn Be•Completed Bg;CIbf 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 ❑ Geo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8%x 11)
❑ Structural Calculations
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for elec.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' Recision to Existing Peru 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 Spdnklered 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 Commis Arch.Review Board Landmark Comm. I I Planning Comm.Zoning Administrator
=ee - City Project Elec.Vehicle Charger Landmark Seismic Retmfltl special case:biag.
ORicialA roval
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Building/Safety Permit Specialist City Planning ICivil Engineering EPWM-Admin I Transportation Mgmt. I Rent Control
IZ - U� THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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