PMT16-01309 City of Menifee Permit No.: PMT16-01309
29714 HAUN RD.
4d%7 ELA? MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued:
04/26/2018
PERMIT
Site Address: 25870 COOMBE HILL DR, MENIFEE, CA Parcel Number: 339-102-026
92586 Construction Cost: $6.840.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT,GARNER 3.0 TON SINGLE STAGE A/C,70K BTU FURNACE
Work:
Owner Contractor
LINDA WILGUS MONK'S AIR CONDITIONING
25870 COOMBE HILL DR 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 Div Amount lSl
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 carded on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise slated,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 0
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 fome and eIf which I must have resided for at least one year prior to completion
License Class. 0 Livens No. Z improvements covered by this permit, I cannot legally sell a structure that 1 hay
Expires�J�J I O Signatu built as an owner-building if it has not been constructed In its entirety by livens(
contractors. I understand that a copy of the applicable law, Section 70" of ti
WORKERS'COMPENSATIONDECLARATION Business and Professions Code,is available upon request when this application
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: htto://www.leginfo.ca.aov/calaw.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 proper
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 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 stale laws relating to buildir
CCC� , construction.I authorize representatives of this city or county to enter the abov
Carrier I / identified property for the inspection purposes.
Policy#I I Z Expires <�— Date
Property Owner or Authorized Agent �J
(This section need not be completed if the permit is for City Business License# lJ 3 6 /
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 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 ecified on the Hazardous Materials Information Guide?
Code,I shall f hwith mply with those provisions. ❑YESNO
Appil anY 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 ❑YES <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 outs
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 State of
agency for the performance of the work which this permit is issued (Section Califomia Health Safety C e,Section 25505 and 25534 conceming
3097 Civil Code) hazardous mate Ire oril
OWNER BUILDER DECLARATIONS ❑YES NO
I hereby affirm under penalty of perjury that I am exempt from he Contractor's Date
License Law for the reason(s)indicated below by the checkmark(s)I have placed PRO6RT<041NkPK 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 IRRP)
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-1976
Section 7000)of DNision 3 of the-Busingss 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 for 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($500).) employees.For more Information about EPA's Renovation Program visit:
www.epa.govilead 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 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 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 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 lid an owner of a property
who builds or improves thereon, and who contracts for the projects with a
,:-----I ___ _— I---- --..._._ "------ --. ,...------'-- ----, ter,.
BUILDING P • P •
Menifee
DATE Z,(� (/J PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL XMECHANICAL
O NEW O PLUMBING C RE-ROOF-NUMBER OF SQUARES -
DESCRIPTION OF WORK (C
�D k P)TO L)ng a ce
PROJECTADDRESS 2-53 22 �4jlI Dr' M l
ASSESSOR'S PARCEL NUMBER.J�J�- ID L- 026- -I LOT TRACT 2- Z
OWNERNAME Lj)n o-S
ADDRESS �\ J 2� V CG I. ) .D r' / l r
PHONE(C� Z J 5 ' S;135 I EMAIL
APPLICANT NNA/M�EC� Ir^ ^ + Mom_ I L.t�
ADDRESS /��XG/Jl�/-�J0 1 v l V�y1�T1 ' � CA L
PHONE (` 15 J a;7q-LI50Ly� /� EMAIL►nonKSGifr2D �I.j • am
CONTRACTOR'S NAME U �-= 1 �/I O �^ OWNER BUILDER? C YES NO
BUSINESS NAME / Ir Cbncbi fbn l G
ADDRESS I �25
PHONE 6;16!- 4,502- /]t 1,EMAIL mCnILSl5 Ir AD ►YX4LR -L • C-D
CONTRACTOR'S STATE LIC NUMBER Cll -ltl` LICENSE CLASSIFICATION CZO
°� L SO FT
VALUATION$ 2.� SQFT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION p�"J CRY OF MENIFEE BUSINESS UCENSENUMBER
BUILDING PLANNING ENGINEERING FIRE li GREEN SMIP
INVOICE i
AMOUNT • I PAID AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER 0 YES O NO
City of Menifee Building&SI fety Department29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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