PMT16-01474 City of Menifee Permit No.: PMT16-01474
_ 29714 HAUN RD. Type: Residential Mechanical
<A—CCEL/ie�.' MENIFEE, CA 92586
MENIFEE Date Issued:
g5111/2016
PERMIT
Site Address: 27532 PINCKNEY WAY, MENIFEE, CA Parcel Number: 336-354-003
92586 Construction Cost: $4,925.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT 3.0 TON, 14 SEER A/C,70,000 BTU FURNACE
Work:
Owner Contractor
BILL MCINTOSH MONK'S AIR CONDITIONING
27532 PINCKNEY WAY P O BOX 128
MENIFEE, CA 92586 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 O0rt Amount fSl
Forced-Air or Gravity-Type Furnace or Bumer 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_BIdg_Pernit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exemptfrom lkensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class License No. By my signature below I acknowledge that,except for my personal residence
Expires Signature in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
❑1 hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which ,,t„wwleginfo.ca.gov/calaw.htmi.
this permit is issued.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
❑I have and will maintain workers compensation insurance,as required by
section 3700 of the tabor Code,for the performance of the work for which ❑By my signature below 1 certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
1 shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to orgreater thatt'e
amounts specified on the Hazardous Materials Information Guide.
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY D Yes ❑No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) ❑Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health al Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 DYes ❑Na
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant forthe permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)orthat he orshe is exempt from Iicensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis forthe alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required forthis project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
APPLICATIONBUILDING SAFETY PERMIT/PLAN CHECK
Menifee
DATE PERMIT/PLAN CHECK NUMBER II
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL MECHANICAL
OINEE'W O PLUMBING C RE-ROOF-NUMBER OF SQUARES �-
DESCRIPTION OF WORK iTVAC� ` Q( U �• n
PROJECIJ, DRE":
ASSESSOR'S PARCEL NUMBER pp 33� 3�-� �y LOT Z 3 TRACT Z 30�1
OWNER NAME
J , I ��IC C
ADDRESS L /�J g
PHONE / _i2 (/ y� EMAIL �
APPLICANT NNA/MMEGL r 1 `.u
ADDRESS /J�cV' J/��70/] �1M 0 -* � � �' CA C125R
PHONE (`7J� ) �P `/I- 502 EMAIL 0Y
CONTRACTOR'S NAME l�l �-� I �/I O' S��.�"w OWNER BUILDER? YEESS
NO
BUSINESS NAME / I Y l..l.)nU I bYl I
ADDRESS//� lS I �25
PHONE l "/S' 1 67 JC n,2 �7/EMAIL mOnI-SG.•Ir a7 ►'n l- • Cam
CONTRACTOR'S STATE LIC NUMBER `�/f 2 I_/n` LICENSE CLASSIFICATION C2-0
VALUATION$ 25 SQ FT \ -SU L SO FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CRY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE �I PAID AMOUNT O CREOIT CARD VISA/MC
AMOUNT il• OCASH OCHECK#
PLAN CHECK FEES PAID AMOUNT 0 CASH O CHECK# O CREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&SPfety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.city finenifee.us Inspection Request Line 951-246-6213
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'Stale License Law forth
I hereby affirm under penalty or perjury that I am licens d 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 h
Professions Code license is in full force and eff L which I must have resided for at least one year prior to completion c
License Class Ucens No. ZL improvements covered by this permit.I cannot legally sell a structure that I have
Expires Signatu built as an owner-building if it has not been constructed in its entirety by licensee
contractors. I understand that a copy of the applicable law, Section 7044 of the
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application is
submitted or at the following Web she:
❑ 1 hereby affirm under penalty of perjury one of the allowing declarations: htto:lhvwwlecinfo.ca cov%ralaw.html.
I have and will maintain a certificate of consent of s If-insure for workers'
compensation,issued by the Director of Industrial Relate ns as provided for by Dale
Section 3700 of the Labor Code, for the performance f work for which this
permit is issued. Property Owner orAuthonked Agent
,Policy# ❑ By my Signature below, I certify to each of the following: I am the propery
n� I have and will maintain workers' compensation ins mince, as required by owner or authorized to act on the property owner's behalf. I have read the:
section 3700 of the Labor Code, for the performance of a work for which this application and the information I have provided is correct I agree to comply
permit is issued.My workers'compensation insurance came and policy number are: with all applicable city andicounty ordinances and state laws relating to buildinc C i^ 1 construction.I authorize representatives of this city or county to enter the above.
Cartier c.�7���7 ) identified property for the inspection purposes.
Policy#� L-' /��� /Z Expires �— — / Date
Property Owner or Authorized Agent
(This section need not be completed if the permit is for CI Business License# /r'''� 2� - 7
one-hundred dollars($100)or less) City l
HAZARDOUS MATERIAL DECLARATION
I certify that in the performance of the work for which is permit Is issued,I
shall not emmlov any persons in any manner so as to ecome subject to the Will the applicant or futurejbuilding occupant handle hazardous material or a
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 reply with those provisions. DYES WIND I
AppleDate;ant• 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 Distridt(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TU CRIMINAL PENALTIES AND DYES KI
CIVIL FINES UP TO ONE HUNDRED THOUOAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounds ofa school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES boundary
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 Safety Cppgm[[�(e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mate Ire morn;A./
OWNER BUILDER DECLARATIONS DYES 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 checkmark(s)I have placed PROk-RT<0dNi AUTHORIZED AGENT
next to the applicable tterri(Section 7031.5. Business acid Professions Code: ,
Any ciy or county that requires a permit to construct,alter,,improve, demolish, EPA RENOVATION.REPAIR AND PAINTING(RRP)
or repair any structure, prior to its issuance, also requiresIthe 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 Contractors State License Law(Chapterig (commencing with receiving compensation for most work that disturbs paint In a pre-1978
Section 7000)of Division 3 of the Business and Profession's Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from licansure 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:
wwwepa.govAead 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,land the structure is
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's Stale License Law dons not apply to an owner of a property ❑An EPA Lead-Safe Cerif.ad 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 improved for the Firm Certification 1 o.:
purpose of sale). N
❑ I, as owner of the property an exclusively contracting with licensed No EPA Lead-Safe Certified Finn is required for this project because:
contractors to construct the project(S"_ on 7044, Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
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