PMT14-02788 i
City of Menifee Permit No.: PMT14-02788
29714 HAUN RD. Type: Residential Mechanical
MENIFEE, CA 92586
MENIFEE Date Issued: 1 012112 01 4
PERMIT
Site Address: 29479 PEBBLE BEACH DR, MENIFEE, Parcel Number: 338-073-002
CA 92586 Construction Cost: $5,000.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT SPLIT SYSTEM HEAT:60,000 BTU COOL:36,000 BTU
Work:
Owner Contractor
MARK TORTOMASI MONKS AIR CONDITIONING
35477 ORO CT P O BOX 128
WILDOMAR, CA 92595 SUN CITY, CA 92586
Applicant Phone: 9516794502
GARY MONK License Number: 912194
MONKS AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description Ot-y Amount($1
AirnHandIing/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 building 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
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 contractor to construct the project(Section 7044, Business and Professi
Professions Cc my license is in full me�rnd a e¢t. Code:The Contractor's License Law does not apply to an owner of a prop
License Olass. . License who builds or Improves thereon, and who contracts for the projects wit
�L Expireti& Signatu licensed ocntractods)pursuant to the Contractors State License Law).
WORKERS COMPENSATION`DECL68glON'
❑ I am exempt from Iicenaure under the Contractors'State License Law foi ,
D 1 hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of sot-insure for workers' By my signature below I acknowledge that, except,for my personal residenk
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 fbr which this Improvements covered by this permit,I cannot legally sell a structure that 11
permit is Issued, built as an owner-building if it has not been constructed in its entirety by licei
Policy# contractors. I understand that a copy of the applicable law,Section 7044 a
❑ 1 have and wi11 maintain workers' compensation Insurance, as required by Business and Professions Coda,Is available upon request when this applicati,
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:httnJlww mleglnfo ca„gpvlcalaw.honL
permit is Issued.My worr�ke�++rs'compenseflon insurance carrier and policy number are:
Cartier DO
Property Owner or. onze en ,Date
Expires �1-y a Policy# 2'' /W 12�
Name of Agent Phone# ❑ By my Signature below, I cerllty to each of the following: I am the pros
owner or authorized to act on the property owner's behalf. I have read
(This section need 04t be completed if the permit Is for application and the info on I have provided Is correct. I agree to oo
one•hundred dollars($100)or less) with all is ble ctty a unty ordinances and slate laws relating to bul
consWctio o' presentetivas of this city or county to enter the at
D I certify that in the performance of the work for which this,permit is issued,I ident fled arty ins action purposes.
shall not employ any persons in any manner so as to become subject to the
workers'compensation laws of California,and agree th !ifI should become
subject to the workers'corapensallon provisio of Be n 3700 of the Labor Pdiner VAuthortzed Agent - Date
Code,I shall forthwith comply with those p ons. _
City Business License# �
Date; .�pplf
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, OYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR
DAMAGES AS PROVIDED FOR IN SECTION 3''706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERY
.LABOR CODE,INTEREST,AND ATTORNEYS FEES ❑NO EQUAL TO OR GREATER THAN THE AMOUNI
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 Tf
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIF
Lender's Name pYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATI(
Lender's Address [I NO FROM THE SOUTH COAST AIR QUALITY MANAGEMEI
DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST R
OWNER BUILDER DECLARATIONS GUIDE LINES
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 checkmark(s)I have placed AYES WILL THE PROPOSED BUILDING OR MODIFIED FACILI'
next to the applicable Items)(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 convict,after, 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
provisions of the Contractor's State Uoense Law(Chapter 9(commencing with I HAVE READ THE HAZARDOUS MATERI
Section 7000)of Division 3 of the Business and Professions Code)or that he or [1YES INFORMATION GUIDE AND THE SCAQMD PERMITT
she is exempt from Iicensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMEP
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFI
a civil penalty of not more than($500).) CODE SE IONMAT 25506RIAL 26533 AND 25534 CONCERN
❑ 1, as owner of the property, or my employees with wages as their sole
compensation,wit 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, -
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: late:
29714 Haun Road Date: Date:
Menifee, CA 92586 - y M
Phone: (951)672-6777 77O07Amount: Ewa
Fax:(951)679-3843 Ck#:
Building Combination Permits
To Be Completed By Applicant
Legal Description: TQ Planning Case: F: L: Rt: R:
Property Address Assessor's Assessor's Parcel Number. 3 3 9�- o-:�-3 (Do
Projec enant Name: 'f02T00 -A-sa--, n n . Unit#: Floor#:
ICnl
Name: n r t V l --7 e� Fax No.
Property Owner Address:zl/l5 ' QbD - I l Unit Number/ Zip Cod
Email Adddrress:`/i; r —// �/ �'7�I
Name: el^.1 r, ^ Q - l,7Z-1(J/
Applicant ddress:305 ,`�` 0 r r _1 Unit Number Zip Code
Emai ddress:M Q rUc S ct i If -6D oi/'Y-) o,._I c('yQ�n /�
Name: MonK'S Air or i M?l (,79--g5C2 / 1v72-2a12
Contractor Addres3^C3O ^ ^ u rnt+n 'r-y I Cll,]t CA eQ Stated yt Zip Codg25nq
antractorlVJ ,t ustnes Icense o. Contractor's $�te��alif fiat/Ll lc`eosat No. l' Classification; /-s i7 O js
Number of Squares: /G l.�L
Square Foctage lk1oZ w O Qo'OW\ .(iOAsp of Description of Work: WV,A4 Ua,q,A6 UIDv= SIFN_r(- • No r- (oo�sty C„a,,. 3bW Cost Of werk:$5 O
pplicanf's Signatu � L Date:
Jq'.Be Completed By,C lty;Staff Only
Indicate As R-Recelved or N/A-Not Applicable
5 Completes sets of fully dimensioned,drawn to sate plans which include: 1 set or documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan
❑ Geo Tech/Sails Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8'/,x 11)
Foundation Plan ❑ Structural Calculations
❑ ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Frarning Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration• Addition' MeanslMethods
Work Type: Repair' Retrofit' Revision to Existing 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 if YES or NO Indicate ail Geo-tech.Haz.Zone
At Project Construction Spdnklered that apply: Coastal Zone
Completion:
Type(s): Coro 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 Retrofit P..ial asr. Idg
O Pidal Aocmval
Expedite Project(s). Child Care City Project Green Building LandmarkI Affordable Housing
For Stall Use Only
Build'nc/Safety Permil Specialist Cily Planning I Civil Engineerng I EPWM-Admin I Transporlalion Mgmt. Rer.I Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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