PMT15-03909 City of Menifee Permit No.: PMT15-03909
_ 29714 HAUN RD. Type: Residential Mechanical
� ELCCA7 MENIFEE,CA 92586
MENIFEE Date Issued: 12/18/2015
PERMIT
Site Address: 28814 WEE BURN WAY, MENIFEE, CA Parcel Number: 339-133-035
92586 Construction Cost: $6,160.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT 3.0 TON UNIT, 70K BTU FURNACE
Work:
Owner Contractor
BETTY KENT MONICS AIR CONDITIONING
28814 WEE BURN WAY P O 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 OQt Amount 1$1
Forced-Air or Gravity-Type Furnace or Burner 1 149.00
Air Handling/Condensing Units SFR 1 133.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Mechanical 1 14.10
$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 building 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 ❑ lam exempt from licensure under the Contractors'State License Law fort[
I hereby affirm under penalty or perjury that 1 am licensed under provisions of following reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence
Professions Code license is in full force and eff t which I must have resided for at least one year prior to completion
License Class Ucens No. Z[ improvements covered by this permit,I cannot legally sell a structure that I ha%
Expires 3-31- !to Stgnatu built as an owner-building if it has not been constructed in its entirety by Iicensr
contractors. I understand that a copy of the applicable law,Section 7044 of ti
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application
submitted or at the following Web site:
[3I hereby affirm under penalty of perjury one the following declarations: hftp:flwww.leainfo.m.gov/mlaw.htmi
I have and will maintain a certificate of consentt of self-insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner orAuthodzed Agent
Policy# ❑ By my Signature below, I certify to each of the following: 1 am the proper
$, I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read th
section 3700 of the Labor Code, for the performance of the work for which this application and the Information I have provided is correct I agree to comp
permit is issued.My workers'compensation Insurance carder and policy number are: with all applicable city and county ordinances and state laws relating to buildir
CC consWction.Iauthodze representatives of this city or county to enter the abov
Carrier S >� )/ identified property for the inspection purposes.
r
Policy#1 2- /bD— /2 Expires <6 Date
Property Owner or Authorized Agent
(This section need not be completed if the permit is for City Business License# 035f 07g
one-hundred dollars($100)or less)
I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ any persons in any manner so as to become subject to the Will the applicant or future-building occupant handle hazardous material or,
workers'compensation laws of California,and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts ked on the Hazardous Materials Information Guide?
Code,I shall f hwi mpiy with those provisions. ❑YES VNeO
Appli ant* Date; Will the intended.use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checkft
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines -
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND ❑YES KIND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the oute
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounds ofa school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAOMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of
agency for the performance of the work which this permit is issued(Section California Health A$y Safety Cp e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mat
nZI-1—
OWNER BUILDER DECLARATIONS ❑YES NOr
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date
License Law for the reasons)indicated below by the checkmark(s)I have placed PROk-RT<0VVNkQA AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5.Business and Professions Code: EPA RENOVATION.REPAIR AND PAINTING(RRP1
Any city or county that requires a permit to construct,alter, improve, demolish,
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 The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law(Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000).of Division 3 of the•Businpss and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from.licensure,and the basis fdr the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 703'1.5 by any Applicant fora permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500)4 employees.For more Information about EPA's Renovation Program visit:
❑ I, as owner of the property, or my employees with wages as their sole www.epa.govAead or contact the National Lead Information Center at
compensation,will do ( )all of or( )porting of the work, and the structure is 1-800-424-LEAD(5323).
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 p An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort; builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name:
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). Firm Certification No.:
❑ I, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Finn is required for this project because:
contactors to construct the project(Section 7044,Business and Professions
Code:The Contractor's License Law does not apply td an owner of a property
who builds or Improves thereon, and who contracts for the projects with a
Menifee
DATE ��� PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL AIESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICALMECHANICAL
O NEW/ O PLUM/BIING O RE-ROOF-NUMBER OF SQUAREST /
DESCRIPTION OF WORK V (
PROJECTADDRESS 2 0rn UDIU
ASSESSOR'S PARCEL NUMBER 13�� 13 3 3� LOT ® 19® TRACT Z7SSZ
OWNER NAME7�f
ADDRESS Z Z ' (A k/ 6A
PHONE N51 )f4 7q- 60(G, EMAIL
APPLICANT��NNccAMII\E &J Y ,
ADDRESS 30550 v Uun " p 7 1l f-e-t CA CIwQ
PHONE (`7�7t l �P�I '�� SV�„ EMAIL►YjpnKSaiwtD rraQ a . Cbaj
CONTRACTOR'S NAME �A I" 1 vl Q _ JJ OWNER BUILDER? O YE NO
BUSINESSNAME C J nd ibrl '
ADDRESS
//� J/�7n , r G��I ( GA q25
944
PHONE l qM CO 1'�l-- 7502- /]' EMAIL mbnk n�!-
Sc*lr Z r • Gorr,
CONTRACTOR'S STATE LIC NUMBER "/1Z IC `I LICENSE CLASSIFICATION
VALUATIONS SO,FT 0 Ze _ L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION t CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PL4NNING eNGIIANEERING FIRE GREEN [ SMIP
INVOICE I' yo PAID AMOUNT
AMOUNT a I I I OCASH OCHECK# OCREDITCARD MWMC
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# OCREDITCARD 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 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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