PMT14-02609 i
City of Menifee Permit No.: PMT14-02609
29714 HAUN RD. Type: Residential Mechanical
la--" MENIFEE, CA 92586
MENIFEE Date Issued: 0 912 6/2 014
PERMIT
Site Address: 25910 ROANOKE RD, MENIFEE, CA Parcel Number: 339-061-018
92586 Construction Cost: $5,800.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT SPLIT HEAT 70,000 BTU COOL 36,000 BTU
Work:
Owner Contractor
BETTY ADAMS MONKS AIR CONDITIONING
25910 ROANOKE RD P 0 BOX 128
MENIFEE, CA 92586 SUN CITY, CA 92586
Applicant - Phone: 9516794502
BETTY ADAMS License Number: 912194
MONK'S AIR CONDITIONING
P 0 BOX 128
SUN CITY, CA 92586
Fee Description Qtv Amount
Air Handling/Condensing Units SFR 1 133.00
Bul di gsr�ltslsslia�c ; � 1 7x.0.=
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
1
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 licen.
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044,Business and Professu
Professions Ccj d my license is in full roe d IfFe Code:The Contractor's License Law does not apply to an owner of a prop,
License Class 4 L Q_License N `7 who builds or improves thereon, and who contracts for the projects wit
Expire Signatu licensed contractor(s)pursuant to the Contractors State License Law).
l"JORKER V COMPENSATION DECLARATION ❑ I am exempt from Ilcensure under the Contractors'-State License Law for
❑ 1 hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of seH-Insure for workers' By my signature below I acknowledge that,except;for my personal residenr
compensation;issued by the Director of Industrial Relations as provided for by which I must have resided for at; least one year prior to cempleticl
Section 3700.ot the Labor Code,for the.performance of work for which this improvements covered by this permit,'I cannot legally sell a structure that I I
permit Is issued, built as an owner-building 9 it has not been constructed in its entirety by Iicel
Policy# contractors. I understand that a copy of the applicable law, Section 7044 o
❑ 1 have and will maintain workers' compensation insurance, as required by Business and,Professions Code,is available upon request when this applicall
section 3700 of the Labor Code,for the performance of the work for which this submitted or at the following Web she:hg5,lf yww leainfo.ca.anvlowaw html.
permit is issued.My workers'compensation Insurance carder and policy number are:
�. /^^+ PropertyOwneror o Agent - ,Date
Carder T'. .._. /'�./� �7 �I
Expires — Pollry# [Z- J W i G'- /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 091 be completed If the permit is for application and the info on I have provided is correct. I agree to cc
one-hundred dollars($100)or less) with ell affc�ftyauty ordinances and state laws relating to but
construcdsentatives of this city or county to enter the al
❑ I certify that In the.perfomuance ofthe work for which this,permit Is issued,I idemtMedaction purposes.
shall not emolov any persons In any runner so as to became subject to the �°r
workers'compensation laws of California, and agree th if I should become f
subject to the workers'compensation provislo of Se n 3700 of the Labor P , ner Authorized Agent Date
Code,I shall forthwith comply with those ons. 3
l� City Business License#
Date; f�' ...J_. APPO
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,COMPENSATION, []YES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR
DAMAGES AS PROVIDED I-OR_IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERII
LA13OR CODE,INTEREST,AND ATTORNEYS FEES - ❑NO EQUAL TO OR GREATER THAN THE AMOUNT
CONSTRUCTION LENDING AGENCY SPECIFIED ON .THE HAZARDOUS MATERIAL
I hereby affirm that under the penalty of perjury there is a construction lending
INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY TI
3D97 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUII
Lender's Name pYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATI(
FROM THE SOUTH COAST AIR QUALITY MANAGEMEI
Lender's Address ❑NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST R
GUIDE LINES
OWNER BUILDER DPRI ARa71QNS
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the reason(s)indicated below by the chedonark(s)I have placed pYES WILLTHE PROPOSED BUILDING OR MODIFIED FACILI'
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, p 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 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 DYES INFORMATION GUIDE AND THE SCAQMD PERMITT
she Is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREME1
violation of Section 7031.5 by any Applicant for a peimlt subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAF
a civil penalty of not more than($500).) CODE SECTION
25505
550 25533 PIEPOF AND 25534 CONCERN
HAZARD❑ 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 7D44,Business and Professions Code; <-,
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, W IFNI�zzl�,
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 MENIFEE PLCK No:
29714 Haun Road Date: D,ate,: ` 1
Menifee, CA 92586 Zb�
Phone: (951)672-6777 Amount: Amount:'
Fax:(951)679-3843 Ck# Ck#:
Building Combination Permit G�
To Be Completed By Applicant
Legal Description:.�Q 3 K Z l.oT 13 Planning Case: F: L: Rt: R
Property Address: Assessor's Parcel Number:
ZS�\ o l2o`(>v�ulcLs t2o 3--z,01 -oil - alY
Project/Tenant Name: VV\5 Unit#: Floor#:
Name: ROLE— � Yrr�s P one o. Fax No.
A ) 301 -5Z1 S!
Owner ZS
Property Address: - Unit Number Zip Code Cl
a�O lZoYavWIGC� (7�il
Email Address:
Name: hone No. ax N
Gt4¢ 0)0 V�1c q� f.-) 5b2 otN10 72 2a12
Applicant Address: Unit Number Zip Code
30>3O YV�v�(L�1.51F'hA �'9 q'2'S-&-U(
Email Address:
V}r�Gt�CavV�vrs�l.{.cwn
ame:
M,.VttL5 IC ��)(e'1G1^C1'SU2 C°I.e5`0v-72-?Al2
Contractor Address: City Stag Zip Code Cl
3 S 0 3� Vvnv f7Nwe'r-A YLO VY\\ :Y�F\M vl
Contractor's City u�iness LicenTe N5. Contractor's City State of California License No. Classification:
3S^6 ��Z\q Lz0
Number of Squares:
Square Footage k 1 Ll
Description of Work:`AVj,,G U�-I,4�/�L� oJT- $rpt�f— N��'r•7 U1L t3TV couL: 3 6 KAT� Cost of work:$ 5 SC o ,
Applicant's Signature Date: q Z b 1
-: To Be Completed ByiGify Staff Ohly -
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 6 Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition' I Means/Methods
Work Type: Repair* Retrofit' Redsion to Ddsting Permit` 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 I YES or NO Indicate all Geo-tech.Haz.Zone
At Project Construction Spdnklered that apply: lCoastal 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 Elec.Vehicle Charger Landmark Seismic Retmfltl Special Case:el g.
Official Approval
Expedite Project(s): Child Care City Project Green Building Landmark I Affordable Housing
For Staff Use Only
Building/SafetyI Permit Specialist I City Planning I Civil Engineering EPWM-Admin I Transportation Mamt Rent Cnntrnl
p
F -1 THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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