PMT16-01475 City of Menifee Permit No.: PMT16-01475
29714 HAUN RD. Type: Residential Mechanical
�l-�CCEL/17. MENIFEE, CA 92586
MENIFEE Date Issued: 0 511 112 01 6
PERMIT
Site Address: 29267 CARMEL RD, MENIFEE, CA 92586 Parcel Number: 338-072-036
Construction Cost: $6,600.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT 3.0 TON, 15 SEER A/C,70,000 BTU FURNACE
Work:
Owner Contractor
PHILLIP OLIVER MONKS AIR CONDITIONING
29267 CARMEL RD P 0 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 Oft Amount!$1
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 eldg_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjurythat I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and in 1 am exempt from licensure under the Contractors 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
❑I 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 workers 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 www.leeinfo.ca.eov/[alaw.html.
this permit is issued.
Policy# Date
❑I have and will maintain workers compensation Insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I 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 an the property owners behalf.I have read this
number are: application and the information 1 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($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
I 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 or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 o 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($500,000),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 o 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 underthe 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.
theckmark(s)I have placed next to the applicable items)(Section 7031.5 oyes ❑No
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 for the perm tto file a signed statement
that he or she is licensed pursuant to the provisions of the Contractor's 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)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint In a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to he RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not mare 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( I portion of the work,and the structure is www.epa.gov/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. o No EPA Lead-Safe Certified Firm 1s required for this 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.
SIR ill • 0111112 ISO N FAIN
io'Menifee
DATE 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 VMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBEROFSC!UARES
DESCRIPTION OF WORK AC
-7C) U-ID
PROJECTADDRESS _Z Z ( G
ASSESSOR'S 4PARC1U.1MAABER ---zS16g'--O Z O 3 b LOT > TRACTOWNER NAADDRESSPHONE! , �T EMAIL
APPLICANT NNA/MMEG-l�.i{ Ir + ,. . p v�
ADDRESS //���J��L/IJ\\J//-�OQQ �� � ���
PHONE (`5 / //�' 15�� p EMAILrrionk501Y•2l7RYYlGI.L� cbrn
CONTRACTOR'S NAME U �-� I I/I O _ .l, OWNER BUILDER? O YES NO
BUSINESS NAME l i r (..//-�.()1 cfi ,or) G
94
ADDRESS
////�-� l5 GA �2�
PHONE ( `?5I I LO 6` -- 4 J[ 9- �]� /EMAIL monl-sCOr a`7 ►`na-/�`l- • CAv>1
CONTRACTOR'S STATE LIC NUMBER gi2I `1 LICENSE CLASSIFICATION C2-0
VALUATION$ 6)00 I SOFT L SO FT
APPLICANT'S SIGNATURE DATE
CI-IYSTAFF USE ONLY
DEPARTMENT DLSTRIBUTIOM p,A'I CrtY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
AMOUNT I Jo PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT
OUNT 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&Sl pfety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from licensure under the Contractors'State License Law for th.
I hereby affirm under penalty or perjury that I am licens under provisions of following reason:
Chapter 9(commencing with section 7000)of Division 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 t which I must have resided for at least one year prior to completion c
License Class M Licens No. Zl improvements covered by this permit, I cannot legally sell a structure that I haw
Expires —3I— 1,9 Signatu built as an owner-building if it has not been constructed in its entirety by Itcenset
contractors. I understand that a copy of the applicable law.Section 7044 of thk
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application is
submitted or at the following Web site:
❑ I hereby affirm under penalty of perjury one t the df-in allowing for workers; htti)://www.legin ca cov)nlaw hlm1.
I have and will maintain a certificate of consent of s If-insure for workers'
compensation,issued by the Director of Industrial Relati ns as provided for by Date
Section 3700 of the Labor Code, for the performance f work for which this
permit is issued. Property Owner orAulhorbed Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the propertl
1 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 thi:
section 3700 of the Labor Code, for the performance of he work for which this application and the information I have provided is correct. I agree to compll
permit is issued.My workers'compensation insurance came and policy number are: with all applicable city ariftounty ordinances and state laws relating to buildinc
C� construction.I authorize representatives of this city or county to enter the above.
Carrier I—i71l, Identified property for the inspection purposes.
Pollcy#_'2-_/VD" I2— Expires '� I t Date
Property Owner or Authorized Agent
(This section needs( be completed ff the permit is for City Business License#one-hundred dollars($100)or less) ty J
I certify that in the performance of the work for which Ihis permit is issued,I HAZARDOUS MATE RIAL DECLARATION
shall not emolov any persons in any manner so as to Become subject to the ,Will the applicant or futurebullding 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 ecified on the Hazardous Materials Information Guide?
Code,I shall f cot mply with those provisions. ❑YESNO
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 SECLIFE WORKERS' Coast Air Quality Management Distddt(SCAQMD)?See permitting checklist
COMPENSATION COVERAGC IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OYES )(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 100D feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounda ofaschooI?
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑YES ZN80
CONSTRUCTION LENDING AGENCY I have read the HazardousiMaterial 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 perm�ntt is issued (Section California Health$$$$$ Safety 0yyycc{{e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous matt 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 reason(s)indicated below by the checkr ark(s)I have placed PROk-ffrKovVNAE9K 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(RRP)
or repair any structure, prior to its issuance, also requiresithe applicant for the
permit to rile a signed statement that he or she is lice nrtsed 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 ins 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 firths 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:
❑ roe www.epa.gov/lead or contact the National Lead Information Center at
I, as owner of the p p rty, or my employees with wages as their sole 1-800.424-LEAD(5323).
compensation, will do( )all of or( )porting of the work,l and the structure is
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law dotes 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 Fimr 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 o�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 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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