PMT15-01923 City of Menifee Permit No.: PMT15-01923
29714 HAUN RD.
G EL-A)' MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 0 7/0 812 0 1 5
PERMIT
Site Address: 27149 BOTTLEBRUSH LN, MENIFEE, CA Parcel Number: 335-362-032
92586 Construction Cost: $5,850.00
Existing Use: Proposed Use:
Description of HVAC CHANGEOUT
Work:
Owner Contractor
ROBERT PAQUA MONKS AIR CONDITIONING
27149 BOTTLEBRUSH LN P O BOX 128
MENIFEE, CA 92586 SUN CITY, CA 92586
Applicant Phone: 9516794502
GARY MONK License Number: 912194
PO BOX128
SUN CITY, CA 92586
Fee Description (,3ty Amount
F Y � 'i;tSrG � - pp u naceor�Burnee 9s00
Air Handling/Condensing Units SFR 1 133.00
GREEN FEE 1 1.00
$310A0
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 ❑ 4 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 Profession
Professions Cc mend my with
sectnse oZN1
e end offs . Code:The Contractor's License Law does not apply to an owner of a proped
License�Gla�ss'. i ,� (Z_Licen q� . e . ... who builds or improves thereon, and who contracts for the projects with
Ex ire�tLL& -Stgnatur licensed contractor(s)pursuant to the Contractors State License Law).
P
WORKERS'COMPENSATION DECLARATION ❑ I am exempt from Iicensure under the Contractors'State License Law for U
❑ 1 hereby affirm under penalty of perjury one of the following declarations:
following reason:
I have and will maintain a certificate of consent of self-ingura 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 ono 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 ha'
permit is issued. - built as an owner-building if it has not been constructed in its enfirety by[loans,
Policy'# contractors. I understand that a copy of the applicable law, Section 7044 of II
Business and Professions Code,Is available upon request when this application
❑ I have and will maintain workers' compensation Insurance, as required by submitted or at the following Web site:http/A i leginfo ca eovlcalaw html.
section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.My worrk
kerrs'compensation insurance carrier and policy number are: rope rty caner or. uthonze Agent ,Date
Carrier T jj /�/f�
Expires Policy# I Z_�W 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 tl
application and the Into on I have provided is correct. I agree to cam
(This section need no be completed if the permit is for with all appli ble city a- ounty ordinances and state laws relating to build
one-hundred dollars($100)or less) constructio adz r presentafives 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 any f t inspection purposes. ��'
shall not emalov any persons In any manner so as to become subject to the
workers' compensation laws of California, and agree th if I should become nor Authorized Agent Date
subject to the workers'compensation provisio of Be n 3700 of the Labor Pro y
Code,I shall forthwith comply with those pro ons.
� City Business License
^Date; 1 r g., f 5 Applic ;
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND R FUTURE BUILDING
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT O
( S IN ADDITION TO THE COST OF.COMPIENSATION,
DYES OCCUPANT HANDLE A AS PROVIDED FOR N SECTION3706 OF HE M XTURE CONTAINING HAZARDOUS AZARDOUSE
RIAL OR A
DAMAGE MATERIAL
EQUAL TO ORLABOR CODE,INTEREST,AND ATTORNEYS FEES ENO SPECIFIED ON THE GREATHAN
MATIERIALE
CONSTRUCTION LENDING AGENCY INFORMATION GUIDE?
I hereby affirm that under the penalty of perjury there is a construction lending WILL THE INTENDED USE OF THE BUILDING BY THI
agency for the performance of the work which this permit Is Issued (Section APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRI
3097 Civil Code)
Lender's Name AYES A PERMIT FOR THE CONSTRUCTION OR M ATI
FROM THE SOUTH COAST AIR QUALITY MANAGANAGEMEN'
Lender's Address ❑NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOI
GUIDE LINES
OWNER n110ERDECLARAI N 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
L HEN PROPOSED
EET BUILDING
THE 0O M BOUIEDARY IOF
LIT
next to the applicable item(s) (Section 7031.5.Business and Professions Code:
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 MATERI,
provisions of the Contractor's State License Law (Chapter 9(commencing with INFORMATION GUIDE AND THE SCAQMD PERMITTII
Section 70e0)of Division 3 of the Business and Professions Code)or that he or DYES CHECKLIST. I UNDERSTAND SC REQUIREMEN
she is exempt from Iicensure and the basis for the alleged exemption. Any
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).) - HAAZARDSECTION
US MATERIAL i4EPORtING D 25534 CONCERNI
❑ 1, as owner of the property, or my employees with wages as their sole PROPERTY OWNER OR AUTHORIZED AGENT
compensation,will do ( )all of or( ) porting of the work, and the structure is
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 properly
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 : APPLICATION
"Menifee
DATE (— j PERMIT/PLAN CHECK NUMBER VI
TYPE: O COMMERCIAL $,RESIDENTIAL - MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION - ELECTRICAL OMECHANICAL
O INIE\Wr O PLUMIBI�NG, O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK (� /I I�C Y U_( '
PROJECTADDRESS 2--� 140 SDI I usk L
ASSESSOR'S PARCEL NUMBER �335"3G2- 032 LOT TRACT I2-7
OWNER NAME -1 00
ADDRESS ` � UV�-� CA o�
PHONE ("1/�SI)3b I " 63y L4 y� ��EMAIL
APPLICANT NAME & Y- 0 ADDRESS 3 5:50 M U Y'rj 1f4TA Ed ., M p rf f /A 25R4
PHONE r/ JI ) (,-- (k?-1f502
EMAILrnot1K5aiy-eD9 rkq: , CDYY1
CONTRACTOR'S NAME U OWNER BUILDER? O YES O NO
BUSINESSNAME / Ir Condi 'b})
ADDRESS S ( GA925944
PHONE (�l//��51) 677q— 45 2 /] EMAIL mon kSA'I r Z Q vy_,L 6_L - Gave
CONTRACTOR'S STATE LIC NUMBER �/'2 `-/ LICENSE CLASSIFICATION C20
q� _ I J L SO FT
VALUATION$ :�x.. �Q SOFT Z tt
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION .l� CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN U" SMIP
INVOICE -//L7 PAID AMOUNT
AMOUNT -CASH -CHECK# -CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES 0 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 951-245-6213
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