PMT14-03353 City of Menifee Permit No.: PMT14-03353
29714 HAUN RD.
'CFIGCEI.-A�. MENIFEE, CA 92586 Type: Residential Mechanical
sma gwt,�P MENIFEE Date Issued: 1211912014
PERMIT
Site Address: 28880 E WORCESTER RD, MENIFEE, CA Parcel Number: 337-140-005
92586 Construction Cost: $2,650.00
Existing Use: Proposed Use:
Description of FAU CHANGE OUT 80,000 BTU
Work:
Owner Contractor
DON &BETTY ASHLEY MONKS AIR CONDITIONING
28880 E WORCESTER 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 QQrt Amount I$1
greed Air of ravlty-Type Furnace orBumer x;; 9 a r 149 00
_. .w v . �...� 2 ,.�
Building Permit Issuance 1 27.00
G�tEEN FEE 1 1 00
$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 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 license
Chapter 9(commencing with section 70o0)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professior.
Professions Cod- d my license is in full rce and effe Code:The Contractor's License Law does not apply to an owner of a proper,
License
2Class. Q_License N ( 9� , _ _ who bullds or improves thereon, and who contracts for the projects with
Expire`L"� Sign Lic licensed contractors)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION ❑ lam exempt from licensure under the Contractors'State License Law for tt
❑ 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 ha,
permit is Issued. built as an owner-building If it has not been constructed in Its entirety by licens,
Policy# contractors. 1 understand that a copy of the applicable law, Section 7044 of t
❑ I have and will maintain workers' compensation insurance, as required by
Business and Professions Code,is available upon request when this application
submitted or at the following Web site: ttlhwvw leolnfo ce covlcalaw htmi.
section 3700 of the Labor Code, for the performance of the work for which this 9
permit Is issued.My workers'compensation insurance carder and policy number are:
F roperly wner or u ooze Agent .Date
Cartier ( ('� �/
Expires I —I C Policy# j I�� w 12' [ /i
❑ By my Signature below, I certify to each of the following: I am the props ,
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read t
(This section need DQ be completed if the permit is for application and the info on I have provided is correct. agree to com
one-hundred dollars($100)or less) with all appli ble city a ounty ordinances and state laws relating to h build
constructio . oriz r presentatives of this city or county to enter the abo
❑ I certify that in the performance of the work for which this permit is issued,I identified arty f inspection 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 Se ' n 3700 of the Labor Pro ner Authorized Agent Date
Code,I shall forthwith comply with those pro ons.
City Business License#
Date; Appli 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 A
DAMAGES AS PROVIDED FOR IN SECTION3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE,INTEREST,AND ATTORNEYS FEES ONO EQUAL TO OR AT
ER THAN THE UNTS
SPECIFIED ON THE HAZARDOUS MATIO ERIALE
CONSTRUCTION LENDING AGENCY 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 THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATIW
FROM THE SOUTH COAST AIR QUALITY MANAGEMEN-
Lender's Address ❑NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOF
GUIDE LINES
OWNER BUILDER 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 checkmark(s)1 have placed DYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITI
next to the applicable hem(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 I HAVE READ THE HAZARDOUS MATERIP
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 []YES INFCHECKLIST. IGUIIDE AND THE AND SC QMD P REMI TIN
she Is exempt from licensure and the basis for the alleged exemption. Any
violation of Section 7031.5 by any Applicant for a permlt subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFE'
a civil penalty of not more than($500).) HAZARDOUS MATERIAL ikEPORI'ING D 25534 CONCERNID
❑ 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; X
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,
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: Date:
Menifee, CA 92586 q
Phone: (951)672-6777 Amount Amount,
Fax:(951)679-3843
Building Combination Permit 41
' To Be Completed By Applicant
Legal Description: .,-12- -Z Sq U LO t Oi,�' Planning Case: F: L Rt: R:
P Address: qS6 r.
�� E• WD� Assessor's Parcel Number.
-P� r2C� Mai cA- 33 .7 two oo,�
Projec enant Name: 43 \"� Unit#: Floor#:
Name: pun 4 L /1s 1� l-e ne o. �3 q Fax No.
Property Trgss: ELJ1 i \� ITJY ^ 1 'n G� Unit Number Zip Code n�
Owner � wv ICU 'Vt I
Email Address:
Name: CW N Na
I"IL.J . u� -L 2
Q I
Applicant 9ddress:3O 5 Unit Number Zip Cade n q
Email Address:rn Qn L 5cA I r1�t�r� /Yl Q(� - Corn
es
Name: l o <15 Air VI ! I • • l'�1�� ��7��5�2 � W�2'Z���
Contractor Address-,Z^C 3O n ,t � r� � _1 Ci11�1 Il( In l is Stater yt Zip Cod�j �
ontraetor It uslnes P1 iicense o. Contracttor'r's City s5j�t ali! 'i\n License t No. l-' Classi-ficatiion: /-a nL.-C)
Number of Squares: l�
Square Footage (o pl
Description of Work: ppQ y G L4-0 v`t- _ � tG BTV Cost of Work:
Applicant's Signatu 7c' Dale:
" " ITo'Ba Completed By,Clty'Staff Only
Indicate As R-Received or N/A-Not Applicable
5 COmplatee sets of fully dimensioned,drawn to sale plans which include: 1 set of documents whicn include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Gen Tech/Soils Report(on ad only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 16 x 11)
❑ Structural Calculations
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan d Delalls ❑ Shoring Plan ❑ Sound Report•Residential
Class Code: Indicate New Construction Alteration' Addition' Means/Methads
Work Type:ElRepair' EJ Retrofit' Revision to Existing Pemtit' RequiredT YES NO
Proposed Building Usil Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have a Basement?
Y of N
Bldg. Code Occupancy Group In icate Indicate it YES or No Indicate all Geo-tech.Haz.Zone
At Project Construction Sprinklemd that apply: Coastal Zone
Completion:
Type(s): C Of 0 O Noise Zone
YES or N
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board I Planning Comm. Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit spaaa Gas.: ng
OKtial Aeeroval
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Budding/Safely Permit Specialist City Planning Crvtl Engineacng EVWM-Admin I Transportation trlgmt. Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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