PMT16-00275 City of Menifee Permit No.: PMT16-00275
29714 Type: Residential Mechanical
�CCELA�. MENIFEE,EE, C CA 92 92586
MENIFEE Date Issued: 02/03/2016
PERMIT
Site Address: 28124 CALLE VALLARTA, MENIFEE, CA Parcel Number: 336-310-001
92585 Construction Cost: $15,305.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT-PACKAGE GAS/ELECTRIC,5 TON A/C 60,000 BTU HEAT
Work:
Owner Contractor
CASA BLANCA VILLAS HOMEOWNERS ASSOC. MONK'S AIR CONDITIONING
5122 AVENIDA ENCINAS P O BOX 128
CARLSBAD, CA 92008 SUN CITY, CA 92586
Applicant Phone: 9516794502
GARY MONK License Number:912194
MONK'S AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description O_yt Amount fbl
Forced-Air or Gravity-Type Furnace or Burner 1 149.00
Air Handling/Condensing Units Non-SFR 1 183.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Mechanical 1 16.60
$376.60
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 licensure under the Contractors'State License Law for If
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 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 har
built as an owner-building if it has not been constructed in its entirety by]loans(
Expires3-3)- 1(O Signatu
wnuactors. I understand that a copy of the applicable law,Section 7044 of 0
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: h�:l/wwwleoinfo.ca.eov/plaw.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 Dale
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 proper
)5( 1 have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. 1 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'compensafion insurance carder 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
Carder :SC-4 F / identified property for the inspection purposes.
Policy#12— /bit— 1Z Expires 6— — ILO Date
Property Owner or Authorized
�Agent
G / �I
(This section need not be completed if the permit is for C' Business License# lJ .J lO l
one-hundred dollars($100)or less) m'
HAZARDOUS MATERIAL DECLARATION
1 certify that in the performance of the work for which this permit is issued,I
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 hwi omply with those provisions. DYES NO
Appli nY 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 XNO
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 IIN SECTION 3706 OF THE bounder
of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑YES 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 State of
agency for the performance of the work which this permit is issued (Section California Health$$A$$$ Safety C9qe,Section 25505 and 25534 concerning
3097 Civil Code) hazardous maFeOWNER BUILDER DECLARATIONS ❑YES
I hereby affirm under penalty of perjury that I am exempt from the Contractors Date
License Law for the reason(s)indicated below by the checkmark(s)I have placed PRO 0 N 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 1RRP1
or repair any structure. prior to its issuance, also requires the applicant for the
permit to rile 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-Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from.Iicensure,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 a 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 EPKs Renovation Program visit:
www.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 1-800-424-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 Contractors 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 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 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 tdan owner of a property
who builds or improves thereon, and who contracts for the projects with a
at
di 9 & S�yOePt "Menifee
DATE fE PERMIT/PLAN CHECK NUMBER Ilv� W
TYPE: ,COMNIfi'kaAd 11RESIDENTIAL 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 Pf� ,f 'T
5;v,.A vo,\C_ too nbu �'1v � ��P-� I �QS,k5t -n ca. V � Lot
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PROIECTADDRESS ZFfLZ* G/} �-`\z- V P, SSO
ASSESSOR'S PARCEL NUMBER 3 3 (o 3\ O 00 k LOT TRACT Z.35 1 Z
OWNER NAME CtA••1��J`Q.f\CO3 V k 45 TJ(D n-xet)wruL rs Assn.
ADDRESS PojZ C-n� I S h� ✓� &
PHONE EMAIL
APPLICANT NAME r^ ^ + , I,�1��� /�p y/�../��p ('y� /fir/�Q� p
ADDRESS /`�JcL,J�J )Q I�vl l V I 1 I " ' t I i I ` t `�1 5 `Y"
PHONE (q5 ) 4; r/q�'-1502 EMAILYnOnKSOiy-tD 0 11-zw • COYYl
CONTRACTOR'S NAME OWNER BUILDER? OYES kO
BUSINESS NAME l r 1.//''`��Un o n
ADDRESS
//� S/ n I r r7 ( GA q25
PHONE (IRM OrPV 4T 50 _ /�_ EMAIL Mon lcSci f r a'7 rn�/-L • Go m
CONTRACTOR'S STATE LIC NUMBER C//G.1C Ll LICENSE CLASSIFICATION C2_0
VALUATION$ LS 30 O SQFT LSQ FT
APPLICANTS SIGNATURE DATECITY STAFF USE ONLY-'
Z/3 '
DEPARTMENT DISTRIBUTION 1 CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING HRE GREEN SMIP
INVOICE . 1( _.(� PAIDAMOUNT
AMOUNT IMP OCISH OCHECK# OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER 0 YES O NO
City of Menifee Building&Safety Department 29714 Hour; Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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