PMT15-01760 City of Menifee Permit No.: PMT15-01760
^ ''-��•-��. 29714 HAUN RD.
;ii C+�i�.t„A> MENIFEE, CA 92586 Type: Residential Mechanical
rrc�mwxucrav a MENIFEE Date Issued: 06/2512015
PERMIT
Site Address: 29289 CALGARY CT, MENIFEE, CA Parcel Number: 338-242-005
92586 Construction Cost: $6,200.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT-SPLIT SYSTEM A/C: 3 TON FAU: 70,000 BTU
Work:
Owner Contractor
ART&NANCY STONE MONK'S AIR CONDITIONING
29289 CALGARY CT P 0 BOX 128
MENIFEE, CA 92586 SUN CITY, CA 92586
Applicant Phone: 9516794502
GARY MONK License Number:912194
MONK'S AIR CONDITIONING
P 0 BOX 128
SUN CITY, CA 92586
Fee Description (3yt Amount($)
�E. :orc d it o,� Cavity-Ty e��urna gID(� Um�`ri�,ctai t� ` 13' 'S'���E� d t' 14900'
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_81dg_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 ❑ 1, 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(Section 7044, Business and Professior
Professions Cog my license is in full roe and etfe Code:The Contractors License Law does not apply to an owner of a proper
License ClaSe License N j 4 _ who builds or improves thereon, and who contracts for the projects with
Expire3 Signatu licensed contractors)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION ❑ 1 am exempt from Iicensure under the Contractors'State License Law for it
❑ 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 1 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 1 he
permit is issued. built as an owner-building if it has not been constructed in ifs entirety by licens
Policy# _ contractors. I understand that a copy of the applicable law, Section 7044 of 11
❑ 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:hfto•/tw wv iminfo ca aov/alawhtml.
permit is Issued.My workers'compensation insurance artier and policy number are:
ror+ perry err or Authorize Agent ,pate
Carrier f
Expires —1 Policy#
❑ By my Signature below, I certify to each of the following: I am the grope
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read t
(This section need not be completed'rfthe permit is for application and the info 'on I have provided is correct. I agree to corn
one-hundred dollars($100)or less) with all appli ble Gry a only ordinances and state laws relating to build'
censtructio oft r presentatives of this city or county to enter the abo-
❑ 1 certify that in the performance of the work for which this,permit is issued,I identified any f inspection purposes.
shall not employany persons in any manner so as to become subject to the
workers' compensation laws of Cal'rfomla, and agree th ff I should become
subject to the workers compensation provisio of Be n 3700 of the Labor Pro er Authorized Agent Date
Code,1 shall forthwith comply with those p ons.
rn City Business License# 3 �
Date; �� •�PPIi
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, AYES 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
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 MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENI
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)I have placed DYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable ftem(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, 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 I HAVE READ THE HAZARDOUS MATERIA
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 OYES INFORMATION GUIDE AND THE SCAQMD PERMITTIN
she is exempt from Iicensure 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($500).) - CODE SECTION
25505RIAL 25533
55 3 WG D 25534 CONCERNIN
❑ I, as owner of the property, or my employees with wages as their sole
compensation,will do( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code; X
The Contractor's State License Law does not apply to an owner of a property
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
BUILDING • I
SAFETYPERMIT/.PERMIT/PLAN CHECK APPLICATION
Menifee
DATE -Z — /S PERMIT/PLAN CHECK NUMBER 1 / 1Co
TYPE: 0 COMMERCIAL XAESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: 0 ADDITION ()ALTERATION :)DEMOLITION O ELECTRICAL ;MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK UU.
.A)L'. FNNV'. }010001kTV /�
PROJECTADDRESS L 2 p,v,t1 e �/
ASSESSOR'S PARCEL NUMBER 3"3S-.Z 00-' - LOT JILA TRACT 00-1
OWNER NAME
ADDRESS 2"���/1 L C�q `�//�
75-g
PHONE ( -7) 34I-5I&5 EMAIL n e m J) Q rye/
APPLICANT NAME &CLrV -: 0 L� /�p p �+,� /��7
ADDRESS nSC 5";J: /DM� U I% I`� 11..E I l ftt 1.A `�I / 5F-
PHONE (/Jl ) LP !L7- 502 p EMAILmonKSa1 r� 1'YIG A, Corn
CONTRACTOR'S NAME l..I cur ► V I Q �^ ,.( OWNER BUILDER? O YES NO
BUSINESS NAME 1 i t Cond l ior) Lna
ADDRESS ""��S (
PHONE (C//?51 ) 6 — 4� 2_ �] EMAIL mon le-salr 4D 9 ry_LC6_L . Gom
CONTRACTOR'S STATE LIC NUMBER `�//Z 1-/ L4 LICENSE CLASSIFICATION CZQ
VALUATION$ GD SO FT Z SZ L SO FT
APPLICANT'S SIGNATURE DATE �2—
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION __7UFdL NJ1Fft BUSINESS NSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ` SMIP Ij✓�i✓•� L Q
INVOICE � C1 W PAID AMOUNT `
AMOUNT >C
Ibw ASH O CHECK N >CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK It O CREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-572-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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