PMT15-01001 City of Menifee Permit No.: PMT15-01001
y.��-` 29714 HAUN RD. Type: Residential Mechanical
'-]414CCell-; ?' MENIFEE, CA 92586
c wk.. MENIFEE Date Issued: 04/20/2015 '.
PERMIT
Site Address: 28773 ERIDANUS DR, MENIFEE, CA Parcel Number: 339-353-002
92586 Construction Cost: $13,300.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT 2 SPLIT SYSTEMS, UPPER: HEAT 70K BTU, COOL 2.5 TON, LOWER HEAT 90K
Work: BTU, COOL 3.5 TON
Owner Contractor
RON LUCAS MONKS AIR CONDITIONING
28773 ERIDANUS DRIVE P O BOX 128
MENIFEE, CA 92586 SUN CITY, CA 92586
Applicant Phone: 9516794502
GARY MONK License Number: 912194
MONKS AIR CONDITIONING
PO BOX128
SUN CITY, CA 92586
Fee Description ,OQt Amount f$1
Air 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 license(
Chapter 9 (commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section7044, Business and Profession;
Professions Code d my license is inffullced effe Code:The Contractor's License Law does not apply to an owner of a propert
License Class.((,,O License N . . who builds or Improves thereon, and who contracts for th@'projects with
Explre,_3, 3 E r rx 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 for lh
❑ 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 ofthe 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 fallowing Web site:http*//www.Ieqlnfo.ca,00v/caIaw html.
permit Is Issued.My workers'compensation Insurance carrier and policy number are:
V^ roperty wner or thonze Agen ut ..Date
Carrier
Expires —I( f—15 Polley#
❑ By my Signature below, I certify to each of the following: I am the proper
Name of Agent Phone# - owner or authorized to act on the property owner's behalf. I have read tY
(This section need not be completed if the permit Is for application and the infor ion I have provided is correct. I agree to comF
one-hundred dollars($100)or less) - with all applic bla city a _only ordinances and state laws relating to buildli
constructio . oriz r presentatives 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 any f t inspection purposes.
shall not emolov any persons in any manner so as to become subject to the �� 3-1f
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 0 ner Authorized Agent Date
Code,I shall forthwith comply with those pr ' ors.
C _ City Business Licanse# �
Date; J .kpplic 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, EYES OCCUPANT.HANDLE A HAZARDOUS MATERIAL OR
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
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 - EYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ❑NO DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS
I hereby affirm under penally 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 EYES 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, E 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 M AT E R I AI
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 - EYES 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($500).) CODE, SECOUS ION 25505RIAL FZE5533 AND 25534 CONCERNIN(
El-1, as owner of the property, or my employees with wages as their sole
compensation, will do ( ) all of or ( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds orimproves the property,
provided that the Improvements are not intended or offered for sale. If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Nenifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL MECHANICAL
O N`E'W O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK VCjnaW Q — Z
Uegok-F-z. v1 70k-ikrv,00ot, z tivo l.ow�rlL'- Va�+V�.rc�o�G-v,�v COOL. 3,S`Nv,,
PROJECTADDRESS 2 Er`dcc-&LIS94 Phi Z42
ASSESSOR'S PARCEL NUMBER 33 q 3 LOT 1 J TRACT ZS-IrS-c1
OWNER NAME c--7®'-7
ADDRESS L O
PHONE (g5/)223 q-(06q l EMAIL
APPLICANTNAME u r ;; 0/ k
ADDRESS 3c0' &50/] M UMr Mtn-[ f-e-e cP CI 5�4
PHONE (q51) (r-;N-Lf 5C y2 p EMAIL II' onk—SQIY'� YYY.I,0 , Corn
CONTRACTOR'S NAM l..{ C r 1 V I O{LK OWNER BUILDER? O YES O NO
BUSINESS NAME Mbnl�!� Or C "nd( an i //�� `
ADDRESS S ( `lZS `f
PHONE I(I`25l / 6 q' 4502- EMAIL mOnV-salr Z 9 n-11C6-L . Gomm
CONTRACTOR'S STATE LIC NUMBER 91219LI LICENSE CLASSIFICATION C20
VALUATION$ 13 3CO SOFT ZbS LSQFT
APPLICANT'S SIGNATURE DATE '
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION •^ CIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN Iv SMIP ITYOF MEN
INVOICE -
AMOUNT Ot7° PAID AMOUNT Z� OWLUECK# ?i)CASH )CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH ()CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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