PMT16-01762 City of Menifee Permit No.: PMT16-01762
29714 HAUN RD.
�/-\CCEL/-> MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 06/0812016
PERMIT
Site Address: 29061 GLEN OAKS DR, MENIFEE, CA Parcel Number: 338-022-004
92586 Construction Cost: $6.600.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, 2.5TON, 14 SEER A/C,70K BTU FURNACE
Work:
Owner Contractor
HELEN A PENNA MONKS AIR CONDITIONING
29061 GLEN OAKS DR P 0 BOX 128
MENIFEE, CA 92586 SUN CITY,CA 92586
Applicant Phone:9516794502
GARY MONK License Number:912194
MONKS AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description py Amount($)
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_Templatexpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from licensure under the Contractors'Stale License Law for thi
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 ii
Professions Code and�Y^license Is in full force and eft which I must have resided for at least one year prior to completion e
License Class_ Z Lic No. 2 improvements covered by this permit.I cannot legally sell a structure that I haw
Expires -3 L� - Signatu ens built as an owner-building if it has not been constructed in its entirety by licenser
contractors. I understand that a copy of the applicable law, Section 7044 of IN
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 the allowing declarations: htto:/Avww.leginfo ca aov/cmlaw html.
I have and will maintain a certificate of consentt of s If-inif-Insure for workers'
compensation,issued by the Director of Industrial Relati ins 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
j� 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 thh
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 compy
permit is issued.Myworkers'compensation insurance carriet and policy number are: with all applicable city and county ordinances and state laws relating to buildinE
C� construction.I authorize representatives of this city or county to enter the above.
Carrier �7�1 ) identified property for the inspection purposes.
Policy#12 —7nO— 12— Explres �— — I Date
Property Owner or Authorized
rrAgent
(This section need not be completed if the permit is for Ci Business License#�l: ( —
one-hundred dollars($100)or less) ty
I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ any persons in any manner so as to become subject to the Will the applicant or future+building 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 writ mply with those provisions. !
DYES No
Appli 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 checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND AYES �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 DYES , NO
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 ASafety Cyyyyyydde,Section 25505 and 25534 concerning
3097 Civil Code) hazardous matey77���
OWNER BUILDER DECLARATIONS ❑YES NOrr
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 PROF"E�04hlk.P4 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
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-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 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:
❑ 1, as owner of the property, or my employees with wages as their sale www.epa.gov/lead or contact the National Lead Information Center at
compensation,will do ( )all of or( )porting of the work,�and the structure is 1-800-024LEAD(5323).
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 Finn Name:
the building or improvement is sold within one year of comp
purpose of sale). letion,the Owner-
Builder will have the burden of proving that it was not built or Improved for the 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 Contractors 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 & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE �� — I PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL 'A RESIDENTIAL O 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 SQU/A,R,ES c I/
DESCRIPTION OF WORK
hC- � S 7 C � Jc���
-7O V L r Q
PROJECTADDRESS _ ffi �1U i
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME not. Q-
ADDRESS I
(12
PHONE /��O I y� /EMAIL -
APPLICANT NAME u�E � r vr�0 C4 �7 Q
ADDRESS /��JIJ\S-`)�}O M U t / 1 " ' I `-'� CA q 5 4
PHONE ` 'O�L„ EMAIL/1'�pnKSa�r� Y1lA l I C�Y1 T
CONTRACTOR'S NAME C �-Ir Y 1 V I O `,, OWNER BUILDER? OYES NO
BUSINESS NAME J i r Cbnd i or)
ADDRESS S/�//� 'r C n GA q25
34
PHONE [ "!SI LO 1'r!- ` ,C) - /]/ ,EMAIL monKsalr Z ►y-tC6L'.L • Gom
CONTRACTOR'S STATE LIC NUMBER C /Z�-/'-/ LICENSE CLASSIFICATION C2-0
VALUATION$ SQFT °� 0\ 2 LSQFT
APPLICANT'S SIGNATURE DATE 0CITY STAFF USE ONLY
b
DEPARTMENT DISTRIBUTION 1 CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN `U0 SMIP
INVOICE O PAIDAMOUNT
AMOUNT TI OCASH OCHECK# OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 HDun Rd. Menifee, CA 92586951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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