PMT16-00079 City of Menifee Permit No.: PMT16-00079
_ 29714 HAUN RD.
'ACCELA? MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued:
01/12/2016
PERMIT
Site Address: 27227 COMWELL ST, MENIFEE,CA Parcel Number: 335331-002
92586 Construction Cost: $6,550.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT 2.5 TON A/C OVER/UNDER HP
Work:
Owner Contractor
CAROLYN MORELAND MONK'SAIR CONDITIONING
27227 COMWELL ST P O BOX 128
MENIFEE,CA 92586 SUN CITY, CA 92586
Applicant Phone:9516794502
GARY MONK License Number. 912194
MONKS AIR CONDITIONING
P O BOX 128
SUN CITY,CA 92586
Fee Description Qttv Amount ISl
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 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 ❑ lam exempt from lioensure under the Contractors'State License Law for I
I hereby affirm under penalty or penury that I 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 eft . which I must have resided for at least one year prior to completion
License Class
I _Licenspil No. 12-19Y improvements covered by this permit,I cannot legally sell a structure that I N
Expire Signstu built as an owner-building if it has not been constructed in its enfirety by licen:
contractors. I understand that a copy of the applicable law. Section 7044 of I
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this applicatior
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: httoJMnvw.leainfo.ca.00vlcalaw.html.
I have and will maintain a certificate of consent 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 or Authorized Agent
Policy# ❑-By my Signature below, I certify to each of the following: I am the propE
'b( 1 have and will maintain workers compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read t
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 com
permit is issued.Myworkers'compensation insurance carder and policy number are: with all applicable city and county ordinances and state laws relating to build
CC� , construction.I authorize representatives of this city or county to enter the abo,
Cartier c.� F_ identified property for the inspection purposes.
Policy#lz_760- 12 Expires
— , Date
Property Owner or Authorized Agent / '
(This section need not be completed if the permit is for D 56 -7 •�
u
one-hundred dollars($100)or less) City Business License# I L
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 s ecifled on the Hazardous Materials Information Guide?
Code,I shall f hvM mply with those provisions. I DYES A NO
Appli an• Date; l�i I l0 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 checkli
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES <NO
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 out
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounds of school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑YES nNO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
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 Cal'domla Health ASafety C e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous matte I re orti
OWNER BUILDER DECLARATIONS ❑YES NO /
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 check marks)I have placed PRO O N AUTHORIZED AGENT
next to the applicable items)(Section 7031.5.Business and Professions Code:
Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION,REPAIR AND PAINTING(RRPI
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 scare-1978
Section 7000)of.DMsion 3 of the-Businjess and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from.Ilcensure. and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 703:1.5 by any Applicant for, permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit:
❑ �•epa.gov/lead or contact the National Lead Information Center at
I, as owner of the property, or my employees with wages as their sole 1-800424-LEAD(5323).
compensation,will do( )all of or( )porting of the work, and the their
is
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 ❑An EPA Lead-Safe Certified Renovator will be responsible for this projec
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.:
EI
❑ I, as owner of the property an exclusively contracting with licensed No EPA Lead-Safe Certified Firm is required for this project because:
contractors 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
BUILDING & •F ETY PERMIT/PLAN CHECK APPLI CATION
Menifee
DATE HLO PERMIT/PLAN CHECK NUMBER (0 00-7
cl
TYPE: O CW4MERCIAL AtESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION 0 ALTERATION 0 DEMOLITION 0 ELECTRICAL�'IKMECHANICAL
O NEW O PLUMBING 10 RE-ROOF-NUMBER OF SQUARES c
DESCRIPTION OF WORK
O Vim(/
PROJECTADDRESS / � n� l � �`i G L1 �2(�p
ASSESSOR'S PARCEL NUMBER 3?�S 3" dDZ LOT TRACT
V
OWNER NAME
Orixnlvyi
ADDRESS ; �� U
PHONE C/,5-/- :>72-,51CJ(3 y� ',EMAIL
APPLICANT NAME (,.�{ r + 1 u J L,, � /�Q� �'p �+,� /��/�p
ADDRESS �,JGV' / -7O/� M V [ {� 1`" I l..F I i T eg CA ` I4J0
PHONE (g5 ) IP (q—g502 A EMAIL►nonICSQIY'� IY�t.I . corn
CONTRACTOR'S NAME U i� / v'oa K OWNER BUILDER? O YES NO
BUSINESS NAME M ir- ndi b
ADDRESS S ( GA `IZS
PHONE (q5l� 6,-7q- 4562 EMAIL monlcsc'tra'-) rr�.C6-L . Gorr,
CONTRACTOR'S STATE LIC NUMBER `mil l Z l-/Li LICENSE CLASSIFICATION CZQ
vil
VALUATION$ SO FT L SO FT II
APPLICANT'S SIGNATURE DATE l� I
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION i CITY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP
INVOICE Y0 PAID AMOUNT
AMOUNT O CASH CHECK# O CREDIT CORD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK# O CREDIT CARD 'AWMC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER 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
FL
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