PMT14-03352 City of Menifee Permit No.: PMT14-03352
29714 HAUN RD.
�1CCIEL/�§, MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 12/19/2014
PERMIT
Site Address: 29690 CARMEL RD, MENIFEE, CA 92586 Parcel Number: 338-062-026
Construction Cost: $2,329.20
Existing Use: Proposed Use:
Description of FAU CHANGE OUT HT 70,000 BTU
Work:
Owner Contractor
DEBRA MC CAMISH MONKS AIR CONDITIONING
29690 CARMEL RD P 0 BOX 128
MENIFEE, CA 92586 _ SUN CITY, CA 92586
Applicant Phone: 9516794502
GARY MONK License Number: 912194
MONKS AIR CONDITIONING
P 0 BOX 128
SUN CITY, CA 92586
Fee Description Q�t Amount I$1
Forced Av:or GrevltyrType Fumace'or Burner 1 ' 149 OD'
.."'A
Building Permit Issuance - _ 1 27.00 ----
Gf{EEN 1.00a
$177.00
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
City Of Men ifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ 11 as owner of the property an exclusively contracting with licens
Chapter (commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professic
Professions Cc d my license Is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a props
Class License License N 1 `7 . , „ who builds or Improves thereon, and who contracts for the projects wRb
Expire jm Signatur licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from Ilcansure under the Contractors'State License Law for
❑ 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 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 h
permit is issued. - built as an owner-building 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
❑ I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http://www.leainfo.ca.gov/ralaw.html,
permit is issued.My workers'compensation Insurance carrier and policy number are:
Carrier (P Property Owner or Aufhorized Agent .Date
Expires �I Policy#
❑ By my Signature below, 1 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 EnA 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 ail appli ble city a ounty ordinances and state laws relating to bulk
constructlo . oriz r presentalives of this city or county to enter the aN
❑ I certify that in the performance of the work for which this,permit is issued,I identified Arty f Ins ection purposes.
shall not employ any persons in any manner so as to become subject to the
workers'compensation laws of California, and agree th if I should become
subject to the workers'compensation provisio of Be ' n 3700 of the Labor Pro ner Authorized Agent Date
Code,I shall forthwith comply with those pro ons. - -�j
City Business License#� / U
Date; APPECLrnt.
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
($700,000),-IN ADDITION TO THE COST OF.COMPENSATION, OYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR P
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑NO EQUAL TO OR GREATER THAN THE AMOUNT:
CONSTRUCTION LENDING AGENCY SPECIFIED ON .THE HAZARDOUS MATERIALS
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 THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATIOf
FROM THE SOUTH COAST AIR QUALITY MANAGEMEN'
Lender's Address ❑NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOE
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 DYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITI
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
provisions of the Contractor's State License Law(Chapter 9 (commencing with I HAVE READ THE HAZARDOUS MATERIP
Section 7000)of Division 3 of the Business and Professions Code)or that he or OYES INFORMATION GUIDE AND THE SCAQMD PERMITTN
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENI
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($500).) - CODE, SECTION 25505 25533 AND 25534 CONCERNII,
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL E'tEPORI'ING,
compensation,will do( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X .
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner- ,
Builder will have the burden of proving that It was not built or improved for the
purpose of sale).
CITY OF MENIFEE PLCK No: P i
29714 Haun Road Date: Date:
Menifee, CA 92586 11 ((f
Phone: (951)672-6777 Amount: Amount, I l
Fax:(951)679-3843 Ck#: Ck#:
Building Combination Permit
To Be Completed By Applicant
Legal Description: F i _ Z�103 LOT 3 N o Planning Case: F: L; Rt: R
Pr�Lo a Address: Assessor's Parcel Number.
►2 RzFs 33S 06Z oZb
Projec errant Name: Unit#: Floor#:
1M L C,�A-+n/��S 4
Name: 10
ro (' p on o3'I7.S-S23 Fax No.
Property tlr ss: 0 1Y1.2� Qd Men l.� C+F} C be
Owner �.O'���J Zip Code�5
Email Address:
Name: �x A ^ yr� Ncu —7
'"l LJ / - 'ZC)(z
Applicant Address:3o V rY- Unit Number Zip Code gZ58
14
fm-ail Address:rrl0rL-eSC( I r- /Y1 CL 1—f . Corm
Name: I " on KIf 5 Aj r =!+-I'wTnQM?/ 679-,4502 /W/-7 2-zoiz
Contractor Addres3^C30
ra ,t ' 1 r,J.1. P I City Apt�l PP Statrf yt Zip Cod
ontractor t Busines icense o. Contractor's City$jet alif -(iaV ILloenlsel N . l' Classili—caattfion: Q nL O
Number of Squares:
Square Footage 01i z—
Descdption of Work: ,F,Av G�V is_C,t— . �T 7C) DO �� Cost of Work:S� 32L n
Applicant's Signatu vim Date: L 7 ICJ
To Be completed By.Clty'Staff Only _
Indicate As R-Received or NIA-Not Applicable
5 Complates sets of fully dimensioned.drawn to sale plans which include: t set of documents whicn include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on BY,x 11)
❑ Structural Calculations
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: indicate New Construction Alteration' Addition' Means/Methods
Work Type: Repair' Retrofit Revision to Existing Pemtit' Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
If Buildings: #Units'. #Stories: Will the Building Have a Basement?
Y of N
Bldg. Code Occupancy Group Indicate Indurate It YES or NO Indicate all Geo-tech.Haz.Zone
At Project Spdnkieretl that
Completion: Construction apply: Coastal Zone
Type(s): C Of O YES or NO Noise Zone
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commis Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit I Spaclal Casa.Bldg
Official Apomal
Expedite Project(s): Child Care City Project Green Building Landmark I Affordable Housing
For Staff Use Only
BuildinglSafely Permit Specialist City Planning I DA Engineering- EPWM-Admin TransporfaCon hlgmt. I Rent Conlrol
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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