PMT16-02683 City of Menifee Permit No.: PMT16-02683
29714 HAUN RD. T Residential Mechanical
'ACCELA� MENIFEE, CA 92586 Type:
NOR— MENIFEE Date Issued: 0 8/1 712 01 6
PERMIT
Site Address: 28270 WINGED FOOT DR, MENIFEE, CA Parcel Number: 337-242-004
92586 Construction Cost: $6,350.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, CARRIER 2.0 TON A/C,45,000 BTU FURNACE
Work:
Owner Contractor
BRYAN HOFFMAN MONWS AIR CONDITIONING
28270 WINGED FOOT DR 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 aty Amount f51
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
$324.10
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Permit Template.rpt Page 1 of 1
BUILDING
PERMIT/PLANAPPLICATION
Menifee
DATE O ( PERMIT/PLAN CHECK NUMBER VQ E I(Q-
TYPE: O COMMERCIAL X RESIDENTIAL O MULTI-FAMILY O MOBILE HOME 0 POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK YK- Charqp C 2— tz')1 _L/
(< 7 L
PROJECT ADDRESS 2 Z� 1 1i I
ASSESSOR'S PARCEL NUMBER �-4'Z�7- 0 LOT � TRACT Z
OWNERNAME I l
ADDRESS IC SG r �L l s�c-b �A g2131
35 7 / —
PHONE EMAIL
APPLICANT NAME
ADDRESS CA3�01 53^0 ML U'rr M I �
/P ! q �`
PHONE (�J� ` /6��-1 S�y� EMAILYYI��'IKSa I r t'Y�-L.� ' �Om
CONTRACTOR'S NAME U �-rn 1 U I D OWNER BUILDER? O YES NO
BUSINESS NAME
ADDRESS/�]GS/�7/1/.]Jcr�I�nI�I�T�I 1�(� -ni
PHONE ( "l5l� C 1`�l� �. �L��� — /], /EMAIL ►YlOnk-Scilr AD ►y-tcCLL • �m
CONTRACTOR'S STATE LIC NUMBER `'�l I2 I-1`1 UCENSE CLASSIFICATION C2-O
VALUATION$ � SO FT L L SO hT
APPLICANT'S SIGNATURE DATE
bTYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION pcc� CRY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 1 SMIP
INVOICE ( ! (C� PAID AN�OUNT 0 CASH 0 CHECK# 0 CREDrr CARD VISAIMC
AMOUNT
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES 0 NO OL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&SPfety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.citydfinenifee.us Inspection Request Line 951-249-6213
City Of Menifee
LICENSED DECLARATION ❑ I am exempt from licensure under the Contredors'State License Law forth
I hereby affirm under penalty or perjury that I am lions d under provisions of following reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below 1 acknowledge that, except for my personal residence b
Professions Code license is In full force and eft which I must have resided for at least one year prior to completion c
License Class= Licens No. Z[ Improvements covered by}his permit,I cannot legally sell a structure that I haw
Expires 3-31- _R _ Signalu built as an owner-building N it has not been constructed in its entirety by licensee
contractors. I understand that a copy of the applicable law, Section 7044 of th,
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application is
❑ I hereby affirm under penalty of perjury one of the s ng declarations: submitted or at the followinb Web site:
•//www I have and will maintain a certificate of consent of s If-inif-insure for workers' htto leminfo a eovjcalaw html.
compensation,issued by the Director of Industrial Relate 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 orAuthoriied Agent
,,Policy# ❑ By my Signature below, I certify to each of the following: I am the propeM
n� I have and will maintain workers' compensation Ins irance. 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 i he work for which this application and the information I have provided is correct. I agree to compy
permit is issued.My workers'compensation insurance carriej and policy number are: with all applicable city andcounty ordinances and stale laws relating to buildint
�[ construction.I authorize representatives of this city or county to enter the above
Carder identified property for the inspection purposes.
Policy#12-700- //2. Expires Date
Property Owner or Authorized Agent
(This section need not be completed if the permit is for
one-hundred dollars($100)or less) City Business License# C/t662-
HAZARDOUS MATE321AL DECLARATION
1 certify that in the performance of the work for which is permit is issued,I
shall not emolov any persons in any manner so as to become subject to the Will the applicant or futureibullding occupant handle hazardous material or a
workers'compensation laws of California, and agree thpt if I should become
subject to the workers'compensation provisions of Section 3700 of the Labor amixture n containing a hazardous material equal I fo greater that the
Code,I shall fq hwi mply with tho:.e provisions. amount�s s{p,ecified on the Hazardous Materials Information Guide?
! DYES✓ NO
Apple anY Datt; 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 DYES XNO
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 bounds oIa school?
LABOR CODE,INTEREST,AND ATTORNEYS FEES ❑YES NC
CONSTRUCTION LENDING AGENCY ! I have read the HazardousMaterial Information Guide and the SCAQMD
1 hereby affirm that under the penalty V perjury there Is a construction lending permitting checklist.I undelstand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health ffafet�� e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mate
OWNER BUILDER DECLARATIONS OYES 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 checkmark(s)I have placed PROk-ffl0aNk.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(RRPI
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 lioerised pursuant to the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law(Chapterlg (commencing with receiving compensation for ost 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 faciliVto be RRP-certified firths and comply with
she is exempt from licensure and the basis for the alle�ed 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 c isturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more infor iation about EPA's Renovation Program vtsit:
www.epa.govAead or contact the National Lead Information Center at
❑ I, as owner of the property, or my employees with ages 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 amid Professions Code;
The Contractor's State License Law dots not apply to an owner of a property who, through employees' or personal effort; builds or improves ❑An EPA Lead-Safe Certif(ed Renovator will be responsible for this project
the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Finn
the building or improvement is sold within one year of completion, the Owner- Name:
;
Builder will have the burden of proving that it was not built o�improved for the Firm Certification: o purpose of sale). N •:
❑ I, as owner of the property an =xclusively contracting with licensed ❑No EPA Lead-Safe Certified Finn 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 She 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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