PMT16-00223 City of Menifee Permit No.: PMT16-00223
29714 HAUN RD. Type: Residential Mechanical
�!-�CCEL A—> MENIFEE, CA 92586
MENIFEE Date Issued: 0112 712 01 6
PERMIT
Site Address: 26070 PINE VALLEY RD, MENIFEE, CA Parcel Number: 337-021-029
92586 Construction Cost: $7,580.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, PACKAGE HEAT PUMP 3 TON, ROOFTOP
Work:
Owner Contractor
ROBERT YOUNG MONKS AIR CONDITIONING
26070 PINE VALLEY RD P 0 BOX 128
MENIFEE,CA 92586 SUN CITY, CA 92586
Applicant Phone:9516794502
GARY MONK License Number:912194
MONKS AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description QQ(t Amount($)
Forced-Air or Gravity-Type Furnace or Sumer 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 violaiJon 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_Peonit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from Iicensure under the Contractors'State License Law for it
I hereby affirm under penalty or perjury 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 tN license is in full force and eff t which I must have resided for at least one year prior to completion
License Class Licens No. 21 improvements covered by this pennit,I cannot legally sell a structure that I he,
Expires3-31- 16o Signatu built as an owner-building if it has not been constructed In its entirety by Iicenst
contractors. 1 understand that a copy of the applicable law,Section 7044 of 9
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application
submitted or at the following Web site:
❑ I hereby affirm under penalty of perjury one the following declarations: htto://www.leeinfo.ca.eov/calaw.html.
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 orAuthorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: I 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 carrier and policy number are: with all applicable city and county ordinances and state laws relating to buildir
construction.I authorize representatives of this city or county to enter the abov
Carrier SCII F_ ) / identified property for the inspection purposes.
Policy#I L^ /b0— I Z Expires 6— f — �CO Date
Property Owner or Authorized Agent
(one-hundred dollars($100)or less)This section need no be completed if the permit is for O--5� u
City Business License# I�
I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not emolov 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 ecified on the Hazardous Materials Information Guide?
Code,I shall f hwit amply with those provisions. ❑YES NO
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 checklis
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES )(IND
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 ZNO
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 Stale of
agency for the performance of the work which this permit is issued (Section California Health gI Safety.C e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mate){Z7���
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 reason(s)indicated below by the checkmark(s)I have placed PROk-M<041NAaP4 AUTHORIZED AGENT
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, EPA RENOVATION,REPAIR AND PAINTING IRRP1
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 Jlcensure.and the basis fdr the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for.a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($5004 employees.For more information about EPA's Renovation Program visit:
❑ I, as owner of theproperty, or m ern to employees with wages as their sale www.epa.gov/lead or contact the National Lead Information Center at
y P Y 9 1-800-424-LEAD(5323).
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;
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 project
who, through employees' or personal effort; builds or improves the properly,
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 Firm Certification No:
purpose of sale).
❑ 1, 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
PERMIT/PLAN
• •
BUILDING : • a • O �xr1 rF a;�Y�rj�.yj
Menifee
DATE Q PERMIT/PLAN CHECK NUMBER M71co' OV3a-3
TYPE: O COMMERCIAL,, ESIDENTIAL 0- MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL -MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK NVVQC- CV\�(oV-0v'V-
^FV v-\ - RVQPTl 9
PROJECTADDRESS }F-0, Nv yV.A`�•� Yu�
ASSESSOR'S PARCEL NUMBER 3 3�' 0 Z r/!Z 01 LOT TRACT 3 b 3
OWNER NAME jZ011 LS\'L'T v J-1 6
ADDRESS Z 1, 44 V4ck-L-1,t
PHONE q 001 -/ZZS-to - s�^ (/e �,� I,EMAIL
APPLICANT NAME
MADDRESS J M M en i Eet Cr q 25
N
PHONE (gGl) (r-;71/-LP502EEMAILrnOnKSair9D 0 YG A - Corn
CONTRACTOR'S NAME Ucyy y QK OWNERBUILDER? OYES O
BUSINESS NAME IY Conan ornI
ADDRESS /� 5/ n , I ''� I GA / LS T
PHONE (`mil51) 6p7q— 4�// 2 /] EMAIL mon KSair Z "-1LCLt-L GDrr-N
CONTRACTOR'S STATE LIC NUMBER `�/'2 1—/ y LICENSE CLASSIFICATION C LQ
VALUATION$ SOFT LSO
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITYOF MENIFFEEE IUSINESS NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP '7GC�✓//LL��J
INVOICE tO PAID AMOUNT .�
AMOUNT • O CASH CHECK# OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# OCREDITCARD VISA/Mc
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.usInspection Request Line 951-246-6213
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