PMT15-00916 i
City of Menifee Permit No.: PMT16-00916
29714 Type: Residential Mechanical
�C.CELA�-.' MENIFEEEE,, C CA 92 92586
MENIFEE Date Issued: 04/13/2015
PERMIT
Site Address: 29345 CHAMPION CT, MENIFEE, CA Parcel Number: 338-183-011
92586 Construction Cost: $5,600.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT-SPLIT SYSTEM HEAT 70K, COOL 36K BTU 3 TON
Work:
Owner Contractor
DELCISE DARE MONKS AIR CONDITIONING
29345 CHAMPION CT P 0 BOX 128
MENIFEE, CA 92586 SUN CITY, CA 92586
Applicant Phone: 9516794502
GARY MONK License Number: 912194
MONKS AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description Oft Amount I$1
Ap,ir Handling/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 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 Ilcenset
Chapter 9 (commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Profession;
Professions 00,d �rd my license is in full rce and effe Code:The Contractor's License Law does not apply to an owner of a piepert,
License Class.( f t� License N . . _ _ who builds or improves thereon, and who contracts for the projects with
Expirel( r Signatur licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from licensure under the Contractors'State License Law forth
❑ 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 i
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 hav
permit is issued. built as an owner-building if it has not been constructed in its entirety by license
Policy# contractors. I understand that a copy of the applicable law, Section 7044 of th
❑ 1 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'1/www leginfo ca govlcalaw html.
permit is issued.My workers'compensation insurance carrier and policy number are:
C ,�� /'�. roperty caner or Authonze Agent Date
Carrier Y f _ �'�/� �7 -
Expires _I i' C' Policy 41�� l.t.i i /_' J
❑ By my Signature below, I certify to each of the following: I am the propel
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read tf
(This section need not be completed if the permit Is for application and the info ion I have provided is correct. i agree to comF
one-hundred dollars($100)or less) with all applicable city a ounty ordinances and state laws relating to buildit
constructio . oriz r presentafives of this city or county to enter the abov
❑ I certify that in the performance of the work for which this,permit is issued,I identified r erty f I inspection purposes, r�
shall not employ any persons in any manner so as to become subject to the 3—i ( —is—
workers'
compensation laws of California, and agree th if I should become (
subject to the workers' compensation provislo 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; .\pplic 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, ❑YES OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA
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 AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
1 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 ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address [I NO DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS
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 ❑YES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s) (Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
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 MATERIAI
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 AYES INFORMATION GUIDE AND THE SCAQMD PERMITTIN(
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENT:
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFET
a civil penalty of not more than($500).) CODE, SECOUS ONMAT 25505RIALf E 533 AND 25534 CONCERNIN(
❑ 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;
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).
pip"
i • e e • • e e
Idj ,Menifee
okDATE Lk 10` 1 S PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL >RESIDENTIAL % MULTI-FAMILY C} MOBILE HOME -1 POOL/SPA O SIGN
SUBTYPE: O ADDITION '4 ALTERATION <' DEMOLITION C% ELECTRICAL kMECHANICAL
O NIIE1W\ /" PLUMBING 1 _0 RE-ROOF-NUMBER OF SQUARES
i'1 V DESCRIPTION OF WORK A L C.V 1[U-w :
4%FA,,r - 7c), OVV
//jj11`` '' {�T0 �ooL '. 3b,000 B'h/ (3 -ran/�,�1 /�
PROJECTADDRESS2_1739,5 l_ 0 �'l�a'1 ] -{' CP '�lZ S-
ASSESSOR'S PARCEL NUMBER 338 l8 3 b l \ LOT 2 9 TRACT 10\ b Lk
OWNER NAME .
ADDRESS 2G' 1" IP Ca C125
PHONE(g5I J 7-1 1-350q EMAIL
APPLICANT NAME r ,.r On LK
ADDRESS n305350n M v r� M-e.nte l fe c� C125R
(%PHONE S/) (p !"/ -1f502 EMAILrnoriKSO i r eD 9 f"YlgiA I Czrn
CONTRACTOR'S NAME Crary 1 yl o LK OWNER BUILDER? :' YES NO
BUSINESS NAME V i r Cond ,o n i
ADDRESS /� "�5 /� �Z It q25
(`�I PHONE SI J 67631 4 EMAIL mon I_Sci I r a7 rr\_0_Lt • Go rr,
CONTRACTOR'S STATE LIC NUMBER U121CILI LICENSE CLASSIFICATION CZ0
VALUATION $ 576 bC) !�!_ SO FT \3�S' L SO FT
APPLICANT'S SIGNATURE DATE L4 1 i u 1111 ,
OTYSTAFFUSEONLY
DEPARTMENT DfSTRIBUTION `,� CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN l SMIP
INVOICE �1 J PAID AMOUNT
AMOUNT V -% CASH C%CHECK# CCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH %CHECK# 'CREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER i; YES `? NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92585 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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