PMT15-02716 I
i
City of Menifee Permit No.: PMT16-02716
_ MENIFEE,
EE, C 92 Type: Residential Mechanical
�1. MENIFEE, CA 92586 j
MENIFEE Date Issued: 0 910 212 01 5 f
1
PERMIT
y
Site Address: 26317 BURLINGTON WAY, MENIFEE, CA Parcel Number: 337-114-008
92586 Construction Cost: $6,050.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT-A/C 3 TON FURNACE 70,000 BTU
Work:
Owner Contractor
CHRISTINE PRECIADO MONKS AIR CONDITIONING
26317 BURLINGTON WAY P 0 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 Qtv Amount is
Air Handling/Condensing Units SFR 1 133.00
GREEN FEE 1 1.00
$324.10
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
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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 lice
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044,Business and Profesi ?,
Professions Co my license ts in full rice and etf Coda:The Contractor's License Law does not apply to an owner of a pro
License Class._ License N ,-,.,., _ who builds or Improves thereon, and who contracts for the projects m
Explrer 1-1j2 �Si® - licensed contractor(s)pursuant to the Contractors State License Law).
t"IORKERS'COMP. N14 TION DECLARATION ❑ 1 am exempt from licensure under the Contractors State License Law f,
[3 1 hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and wilt maintain a certificate of consent of nsum for workers' By:my signature below I acknowledge that,except,for my personal resides
compensation,Issued by the Director of Industrial Relations as provided for by which I must have melded .for at least one :year 'prior to complett
Section 3700'..of the Labor Code,for the performance of work fbr which this improvements covered by th s permit,I cannot,legOly sell a structure that I
permit is Issued. built as an owner-building If it has not been constructed In its entirety by Ilo j
Policy# contractors. I understand that a copy of the applicable law, Section 7044
❑ 1 have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this applies
section 3700 of the Labor Coda, for the performance of the work for which this submitted or at the following Web site:ft*&ww leainfc ca gWca1mmhtml,
permit Is Issued.My workers'oompensaton insurance carrier and policy number are:
t^ Property owner or car¢. ,Date
Carrier T"-/ �I/�
Expires —1 lll./
Policy# I�� iG"
Phone# ❑ By MY Signature below, I certify to each of the following: I am the pr
Name of Agent
owner or androrized to act on the property owner's behalf. I'have rea
(This sector need be completed if the permit is far , application and the Ido 'on I have provided Is correct. I agree to k
one-hundred dollars($100)or less) with all appli bie dy only ordinances and state lam relating to b
consbuct o resanta0ves of this city or county to enter the I
❑ 1 cerfity that in the performance of thq work for which this permit is issued,I identified t in Action purposes.
shall not emciav any persons in any manner so as to become subject to tine
workers'compensation laws of Californta,end agree th t I should become
subject to the workers'compensation provisi of n 3700 of the Labor P mer Authorized t Date
Code,I shall fortmvith comply with those ons. .�7
City Business License# 0
Date; Apple
WARNING: FAILURE- TO SECURE WORKERS' HA9ARDOUSNIA[19RLALDECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHAH
SUBJECT AN EMPLOYER TG.CRIMiNAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDII
($100,000),IN ADDITION TO THE COST OF.COMPENSATION, ❑YES OCCUPANT HANDLE A HAZARDOUS MATERIAL OI
DAMAGES AS PROVIDED FOR IN SECT 110ki 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERI
LABOR CODE,INTEREST,AND ATTORNEYS FEES O EQUAL TO OR GREATER THAN THE AMOUN
¢�NSLCTIONLENOINOAGENCY SPECIFIED ON .THE HAZARDOUS MATERIA
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 rued (Section WILL THE INTENDED USE OF THE BUILDING BY 1
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQU
Lender's Name OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICAM
FROM THE SOUTH COAST AIR QUALITY MANAGEMF
Lender's AddressO
DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST F
O 'ER BUILDER DECLARATIONS - GUIDE LINES
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the ranon(s)indicated below by the checkrnark(s)I have placed OYES WILLTHE PROPOSED BUILDING OR MODIFIED FACIL
next to the applicable Item(s)(Section 7031.5.Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY C
Any city or county that requires a perm to conuot,alter,improve,demolish, O 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 lo the I HAVE READ THE HAZARDOUS MATEF
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 �PcS INFORMATION GUIDE AND THE SCAQMD PERMIT
she is exempt from Ifcensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREME
violation of Becton 7031.5 by any Appikant for a pei mft subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAI
a civil penalty of not more than($500).) CODE SECTION 25505 33 ANINGD 25534 CONCERI
NG
❑ I, as owner of the property, or my employees with wages as their sole HA2AffD0US MATERIAL O ORIZ.
compensation,will do( )all cif or( )poring of the work,and the structure Is P W UTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property
who, through employees' or personal effort, builds or Improves the property,
provided that the Improvements are not Intended or offered for sale.If,however,
the building or Improvement Is sold within one year of oompleton,the Owner-
Builder will have the burden of proving that it was not bust or improved for the
purpose of sale).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
.Menifee
DATE 9 —I PERMIT/PLAN CHECK NUMBER INTO, 1 I
TYPE: O COMMERCIAL AIESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL�>KMECHANICAL
O NEW rO PLUMBING O RE-ROOF-NUMBER OF SQUARES
D ICRIPTION OF WORK 4V/kC. , e. - -A/C- 3• 0 j
Ij rn n c e -7p L�CC(�> P�TU
PROJECTADDRESS ZL3 - T,[ UC kjz C'4 qz%
ASSESSOR'S PARCEL NUMBER ���'�O�rS' LOT TRACT Zj�\A
OWNER NAME h I ���'� \\ /�
ADDRESS Z 3i -7 0 r J WG( /, �� �, I�l I � � g2-5�6
PHONE 51 ' ��EMAIL
APPLICANT NAME ( �{ r ►y� k/
ADDRESS /3�c0' 530/� �'M U rrr Men ( � CA C1 5R
PHONE (`751 ) �-!7 - 502 EMAIL► -IC)n 50 i Y 9D @ rr1GL,A - C,6rn
CONTRACTOR'S NAME 1/%�.1 C' I / vl QrLX OWNER BUILDER? O YES NO
BUSINESS NAME - 1 I1' Cpn& br) l
ADDRESS////�� 5 ( "/Z�j
PHONE ( qQS 1,p `6/- 4,�n2 /] EMAIL mn pKSClr aD Glrnu:-L . G m o
CONTRACTOR'S STATE LIC NUMBER `mil I Z 1C y LICENSE CLASSIFICATION �ZQ
VALUATION$ /�� SOFT 1�� ® L SQ FT
APPLICANT'S SIlG�NATURE 1� DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOICE I• PAIDAMOUNT
AMOUNT OCASH OCHECK# 0CREDIT CARD VISA(MC
PLAN CHECK FEES PAID AMOUNT OCASH 0CHECK# OCREDITCARD VIWMC
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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