PMT14-02607 City of Menifee Permit No.: PMT14-02607
29714 HAUN RD.MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 09/26/2014
PERMIT
Site Address: 29569 AVIDA DR, MENIFEE, CA 92584 Parcel Number: 339-222-011
Construction Cost: $6,670.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT-SPLIT HEAT 60,000 BTU COOL 36,000 BTU
Work:
Owner Contractor
THOMAS HERMSEN MONKS AIR CONDITIONING
29569 AVIDA DR P 0 BOX 128
MENIFEE, CA 92584 SUN CITY, CA 92586
Applicant Phone: 9516794502
GARY MONK License Number: 912194
MONKS AIR CONDITIONING
PO BOX128
SUN CITY, CA 92586
Fee Description ON Amount l$1
Air Handling/Condensing Units SFR 1 133.00
6 i goer' tz's�,t�ange :� � 2A
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 staled,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_Bog_Permit_Template.rpt Page 1 of 1
City Of Menifee
INCENSED 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 licen
Chapter (commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044,Business and Professi
Professions Coff���pd my license is in full force and effe Code:The Contractor's License Law does not apply to an owner of a props
License Cis ss.E `L�License N who builds or improves thereon, and who contracts for the projects wit
Explre3�3 t-►des 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 foi
❑ I 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 resident
compensation;Issued by the Director of industrial Relations as provided for by which I must have resided for. at; least one year prior to completioi
Section 3700'..of the Labor Code,for the performance of work for which this improvements covered by this pemilt,I cannot:legally sell a structure that I I
panoft is issued. built as an owner-bullding If it has not been constructed In its entirety by licei
Policy# contractors. I understand that a copy of the applicable law, Section 7044 0
❑ 1 have and will maintain workers' compensation Insurance, as required by Business and Professions Code,is available upon request when this appilcatl�
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web she:htto•/Avww leainfo ca aov/calaw html.
permit is Issued.My workers'compensation insurance carrier and policy number are:
roperty e-r orAuthorized Agent - ,.Date
Carrier P �I/�
Expires I Policy# �� l W i - ! /i
❑ By my Signature below, I certify to each of the following: I am the pro
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have reac
(This section need i4 be completed'rf the permit is for application and the Into 'on I have provided is correct. I agree to cc
one-hundred dollars($100)or less) with all appli ble city unty ordinances and state laws relating to bu
ansWctio onz presentatives of this city or county to enter the at
❑ 1 certify that In the.performance of the work for which this,permit is issued,I Identified any inspection purposes,
shall not employ any persons in any manner so as to become subject to the �g„� Ll
workers'compensation laws of Caiifomia,and agree th 'rf I should become
subject to the workers'compensati!h':2Pns.
provislo of 5e n 3700 of the Labor Pro nor Authorized Agee Date
Code,I shall forthwith comply with 3
City Business License#
Date; �Zg� L •tPPll
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 BUILDIN
($100,000), IN ADDITION TO THE COST OF.GOMPENSATION, OYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR
DAMAGES AS PROVIDED FOR IN SEC.TION'3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERh
LABOR CODE, INTEREST,AND ATTORNEYS FEES ONO EQUAL TO OR GREATER THAN THE AMOUN'
enasraurTinN 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 TI
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUII
Lender's Name OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATII
FROM THE SOUTH COAST AIR QUALITY MANAGEME
Lender's Address ONO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST Ft
GUIDE LINES
0WNERBUILj2F8.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 chedanark(s)I have placed OYES WILL THE PROPOSED BUILDING OR MODIFIED FACILI
next to the applicable ftem(s)(Section 7031.5.Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY 01
Any city or aunty that requires a permit to construct, after, improve, demolish, ONO 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 HAVE READ THE HAZARDOUS MATER
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 SCAQMO PERMIT-i
she is exempt from Iicensure and the basis for the alleged exemption. Any CHECKLIST. 1 UNDERSTAND MY REQUIREMEI
violation of Section 7031.5 by any Applicant for a permft subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAP
a civil penalty of not more than($500).) COODAERDOHAZU3 ON 25505ATERIAL f';E 533 AND 25534 CONCER
❑ I, as owner of the property, or my employees with wages as their sole
compensation,will do( )all of or( )porting of the work,and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not Intended or offered for sale.(Section 7044,Business and Professions Code; 'gym^`
The Contractor's State License Law does not apply to an owner of a property X_
who, through employees' or personal effort, builds or Improves the property, ; :, ,
provided that the improvements are not intended or offered for sale.if,however,
the building or Improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF M ENIFEE PLCK No: I4_ 60`7
29714 Haun Road Date: Date:
Menifee, CA 92586 Q la.Ilo I I%V
Phone: (951)672-6777 Amount: Amoun (�O
Fax:(951)679-3843 Ck tr Ck#:
Building Combination Permit t
To Be Completed By Applicant
Legal Description:TrZ 2 3-'S ` �-A _ 3 Lo T— ZO Planning Case: F: L: Rt: R
Property Address: Z 9 S`I A v 9v irk 17t2 Assessor's Parcel Number. 3 ,7,2� 2 _D)
Projectffenant Name: \6 v l I
Unit#: Floor#:
Name: "y\-o tM�AS �S'��12tM S 1f1�
e o. Fax No.
Property Address: J Number
-x-l.o�2
Owner ZaL J 6 VT A- D1Z - Unit Number Zip Code q Z,Ssr-
Email Address:
Name: Phone No. axN
qsl 6'72-2Dt2
Applicant Address: Unit Number Zip Code
Email Address:
Name:
iM ,, F,e
oV1k S I 5 C �,%)NO.-N -U1x 1�No\� b'72-Zo12
Contractor Address: City State Zip Code
3oS3� vvv�2Yur�•+-ra YI%p �
Contractor'3 k/ a<mess icense o. ContracW�r'`C�ry`Sgte of California License No. Classification: �Z u
Number of Squares: 1O
Square Footage 1 S-%A b
Description of Work: it4\/1QG GW.M6t��� Cost of Work:$
SOrST� HvsY>c:(iD ATV fAol,'. 3(0�'8?VApplicant's Signature Date: q. 1
To Be Completed By'City 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 ❑ Goo Tech/Solis Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 1A 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 I ❑ Sound Report-Residential
Class Code: Indicate Naw Construction Alteration' Addition' Means/Methods
Work Type: Repair, Retrofit Ra blon to Fxisfing Peur 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 Sprinklered that a i Coastal Zone
Completion: Construction PP Y
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. I Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit Peclal case:6idg,
Official Approval
Expedite Project(s): Child Care City Project Green Building Landmark I Affordable Housing
For Staff Use Only
Building/Safety Permit Specialist City Planning Civil Engineering EPWM-Admin I Transportation Mgml. I Rent Control
P— 1 THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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