PMT16-01761 City of Menifee Permit No.: PMT16-01761
29714 HAUN RD. Type: Residential Mechanical
�CCELA? MENIFEE, CA 92586
MENIFEE Date Issued: 0 6/0 812 01 6
PERMIT
Site Address: 29050 OLYMPIA WAY, MENIFEE, CA Parcel Number: 338-045-012
92586 Construction Cost: $6,300.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, 3.0 TON A/C(14SEER),70K BTU FURNACE
Work:
Owner Contractor
DON STARNER MONKS AIR CONDITIONING
29872 SHARON WAY 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 QtV Amount IS)
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_Bldg_Permit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ I am exempt from icensure under the Contractors'State 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 i!
Professions Code license is in full force and eff which I must have resided for at least one year prior to completion c
License Classy Licens No. )Z[ improvements covered by this permit, I cannot legally sell a structure that I haw
1L
Expires3_31_ j 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 thi
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 thefollowing declarations: http:/Avww.leginfo.ce gov/calaw html.
1 have and will maintain a certificate of consentt of self-Insure for workers'
compensation,issued by the Director of Industrial Relate 3ns as provided for by Date
Section 3700 of the Labor Code, for the performance f work for which this
permit is issued. Property Owner orAuthodzed Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the property
'd 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 thi:
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 compll
permit is issued.My workers'compensation insurance camei and policy number are: with all applicable city and'.ceunty,ordinances and state laws relating to buildinc
C� construction.I authorize representatives of this city or county to enter the above
Cartier � c I Identified property for the Inspection purposes.
Policy#� G—�b��' �Z Expires �— — ! Date
Property Owner or Authorized Agent
(This section need not be completed if the permit is for C' Business License# ! C/ " J�� -7 one-hundred dollars($100)or less) -�
I certify that in the performance of the work for which}his permit is issued,I HAZARDOUS MATERIAL DECLARATION-
shall not employ any persons in any manner so as to blecome subject to the Will the applicant or future?building occupant handle hazardous material or a
workers'compensation laws of Califomia, and agree thpt 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 hwi mply with those provisions. ! DYES 0
Apple ant• Date; Will the intended use of the building by the applicant or future building
WARNING: FAILURE TO SECURE WORKERS' occupant require a permit for the construction or modification from South
Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES �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 outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounda ofa school?
LABOR CODE,INTEREST,AND ATTORNEYS FEES ❑YES , NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affnni 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 C e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mate Z7���
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 reasons)Indicated below by the checkmark(s)I have placed PRA DVVN 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 requires,the applicant for the
per eft 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 Business 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 paintAisturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more Information about EPNs Renovation Program visit
❑ www.epa.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,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 will Lin one year of completion,the Owner-
Bullder 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 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
BUILDING I'Wenifee
DATE PERMIT/PLAN CHECK NUMBER 1 Q` i `
TYPE: O COMMERCIAL �t RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL K.MECHANICAL
C NEW C PLUMBING C RE-ROOF-NUMBER OF SQUARES 1/
DESCRIPTION OF WORK fYC G n
PROJECTADDRESS 2Qc�— Cl )
ASSESSOR'S PARCEL NUMBER 33 V 0"ems P�Z LOT ZZ,,-k TRACT Z '
OWNER NAAME I 0 ) ,,�I .� y
ADDRESS Lq.S -7 2/y -! L 1,A{)n I�I d ' " ""j/)
PHONE( G���I L� O� EMAIL
APPLICANT NAME Y
ADDRESS //3�53o CA q���
PHONE (` 51� 47q-L[501- EMAILrnpnKS0ir9Dgr�'1Gt;L.! • Corn
CONTRACTOR'S NAME U L=/ 1/1 O� 1--� OWNER BUILDER? C YES NO
BUSINESS NAME MOrIL, I I' Cbnd �bnr) 1 Q
ADDRESS
///�G lS// /�]� � ' r C A/I i GA r25
PHONE ( qS� / LO�`�f K J62- /]' /EMAIL rY IDS j f r r� ►'nQ-/�-��/• m
CONTRACTOR'S STATE LIC NUMBER `mil I -JCl `l LICENSE CLASSIFICATION I�LrO
// ��
VALUATION$ l(J SQ FT �`- L SQ FT
APPLICANT'S SIGNATURECITY STAFF USE ONLY
DATE
DEPARTMENT DISTIUSUTION /� CRY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN �J SMIP
AMOUNT INVOICE i® PAID AMOUNT 0 CASH O CHECK# O CREDR CARD VISA/MC
PLAN CHECK FEE.;• PAID AMOUNT 0 CASH O CHECK# O CREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES C NO
City of Menifee Building&Safety Department29714 Haun Rd, Menifee, CA 92586 951-672-6777
www.city I enifee.us Inspection Request Line 951-246-6213
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