PMT16-02807 City of Menifee Permit No.: PMT16-02807
29714 HAUN RD. Type: Residential Mechanical
'C��CCIELA—> MEN]FEE, CA 92586
MENIFEE Date Issued: 08/3012016
P E R M I T
Site Address: 28310 CALLE LUSTROSOS, MENIFEE, Parcel Number: 336-322-006
CA 92586 Construction Cost: $6,200.00
Existing Use: Proposed Use:
Description of HVAC CHANGE,CARRIER 2.5 TON, 15 SEER,SINGLE STAGE SPLIT A/C SYSTEM,45,000 BTU
Work: FURNACE,3.0 COIL
Owner Contractor
ANGIE SAMSON MONKS AIR CONDITIONING
28310 CALLE LUSTROSOS P 0 BOX 128
MEN IFEE, CA 92586 SUN CITY, CA 92586
Applicant Phone:9516794502
GARY MONK License Number: 912194
MONKS AIR CONDITIONING
P 0 BOX 128
SUN CITY, CA 92586
Fee Description Amount(S)
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
$324.10
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of effors in the plans and
specifications or from preventing builiding operations being carded on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced wilthin six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
Akl3ldg_PermfLTemplate.rpt Page 1 of 1
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL Y1 RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION OALTERATION ODEMOLMON OELECTRICAL 4(MECHANICAL
ONEW OPLUMBING 0 RE.ROOF-NUMBER OF SQUARES�
DESCRIPTION OF WORK +NhC C1 2,!S-
banqe, nui,
15 C BT-0 Fu �,
PROJECTADDRFss 2ff) 0 If I iA 1UP y)'Ife-Q Cq L4�
::: C_ Is
ASSESSOR'S PARCEL NUMBER 33 (o 00 LOT 75-) TRACT 6r -3
OWNER NAME
ADDRESS
/5 L/ S EMAIL
PHONE 30L
APPLICANT NAME r_ M(-)
ADDRESS ;zd Mtr�l t, CA q25R4
PHONE
(r--;7 L7-4 502 EMAILn-OrIK 4a i r tD ornall - C-byn
CONTRAcToresNAmE CTCJ-r�/ MCILIK OWNERBUILDER? OYES i NO
BUSINESSNAME M rjj� C125
ADDRESS ��0530 Mj ) r_r_'114n kd 9 kk Iff-C' f CA
D 9
PHONEMM 6�70- _-n9- EMAIL rYibnV_S&jr A
r- 4,'
CONTRACTOR'S STATE LIC NUMBER Pf2 lqq LICENSE CLASSIFICATION Cz,0
VALUATION$ i��,2M c—" sQFr L SQ FT
APPUCANVS SIGNATURE DATE
C17YSTAFF USE ONLY
DEPARI'MENT DISIFLIBUTION OF MENIFEE BUSINESS LICENSE NUMBER
G7
BUILDING PLANNING EN61NEERING FIRE GREEN SMIP
PAID AMOUNT 0 CASH 0 CHECK It OCREDITCARD %nSA/MC
PLAN CHECK FE.gESPAID AMOUNT 0 CASH 0 CHECK# OCREWCARD VISAIMC
OWNER BUILDER VERIRED 0 YES 0 No DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.citycfmenifee.us Inspection Request Line 951-246-6213
City Of Menifee
LICENSED DECLARATION 0 ]am exempt from fi�sure under the ContractorEr State License Law fort
I hereby affirm under penalty or pe4ury that I am licensed under provisions of following reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknoMedge that,except for my personal residence
Professions Code license Is In ILI roe and a which I must have resided for at least one year prior to completion
U.canse Cla� MT LI No. 2- Improvements covered by this permit I cannot legally sell a structure that I he
Explres3-31—IR' SIgnatu built as an owner-building If it has not been constructed In Its entirety by ficens
I conbactars. I understand that a copy of the applicable law,Section 7044 of I
WORKERS'COMPENSATION DECLARATION Business and Professions Code,Is available upon request when thIs application
subrrdtted or at the following Web-site:
D 1 hereby affirm under penalty of pedury one of the following declarations- leqInfi0.ca-qov/caIaw.htmI.
I have and will maintain a certificate of consent of seff-insure for workers: 1317h)
compensation.Issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code,for the performance of w6rk for which this
permit Is Issued. Property Owner orAuthorized Agent
Poficy# 0-By my Signature below, I certify to each of the fdlowing:I am the prope
V, 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 tl
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 agreeto coml
permlitis Issued.Myworkers!compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to bulldi
�5_� F_ construction.I authorize representatives of this city or county to enter the abD%
Carrier I , — Identified property for the Inspection purposes.
Policy#12--70 -2— Ex Date
0— t Pines Property Owner orAuthorized Agent
(This section need DcoA be completed If the permit Is for Chy Business License 0:�) 5409
one-hundred dolfars($100)or less)
4 1 car*that In the performance of the work for which this permit Is Issued,I HAZARDOUS MATERIAL DECLARATION
shalt 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
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 370D of the Labor amounts cified on the Hazardous Materials Information Guide?
Code I shall mply with those provisions. 0 YES VNe)
Appl� nt, Date; Nil the Intendertuse of the building by the appilcantortubure building
ZM occupant require a pemnit for the construction or modification from South
WARNING- FAILURE TO SECURE WORKERS' Cca"r Quality Management District(SCAQMD)?See permitting checkli
COMPENSATION COVERAGE It UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES J<NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000),IN ADDITION TO THE COST OF COMPENSATION, VVill the proposed building or modified facility be within 1000 feet of the out
DAMAGES AS PROVIDED FOR71IN SECTION 3706 OF THE boundarx of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES 0,NO
CONSTRLICTION LrNDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of pedury there is a construction lending penmitling checklist.I understand my requirements under the State of
agency for the performance of the work which this permit Is Issued(Section Cafifomla Health A Safety Cgqe,Section 25505 and 25534 concerning
3097 Civil Code) hazardous(mate
DYES NO
OWNER BUILDER DECLARP-TIONS Date
I hereby affirm under penalty of pedury that I am exempt from the Contractor's
License Law for the reason(s)Indicated below by the checkmark(s)I have placed PRO kR AUTHORIZED AGENT
next to the applicable Item(s)(Section 7031.5.Business and Professions Code:
Any chy or county that requires a permit to construct alter,Improve.demogsh, EPA RENOVATION,REPAIRAN PAINTING(RRPI
or repair any structure,prior to its issuance,also requires the applicant for the
permit to file a signed statement that he or she Is licensed pursuant to the The EPARenovation,Repalrand Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law(Chapter 9 (commencing with receiving compensation for most work that disturbs paint In a pre-1 978
Section 7900).of Division 3 ofthe-Busln�ss and Professions Code)or that he or residence or childcare facility to be RRP�certifed firms and comply with
she Is exempt fimm Jloensure.and the basis feir the alleged exemption, Any required practices.This Includes rental property owners and property
violation of Section 703'1.5 by any Applicant for.A permit subjects the applicant to managers who do the paInt-disturbIng ivork themselves or through their
a civil penalty of not more than($SDDj.y employees,For more Information about EPNS Renovation Program visit:
www.epa.govAead or contact the National Lead Information Center at
0 1. as owner of the property; or my employees With wages as their sole 1-800424-LEAD(5323).
compensation,will do( )all of or( ,porting of the work,and the structure is
not Intended or offered for sale.(Section 7D44,Business and Professions Code;
The Contractor's State Ucense Law does not apply to an owner of a property 0 An EPA Lead-Safe Certified Renovator will be responsible for this prolec
who, through employees'or personal effort; builds or Improves the PrOPertA
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 completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the Firm Certification No.:
purpose of sale).
0 1, as owner of the property a.n exclusively contracting with licensed 0 No EPALead-SafeCertified Finn Is required forthis prOjectbecause:
ormt-actors to construct the project(Bection 7044,Business and Professions
Code:The Contractor's License Law does not apply 16 an owner of a property
who builds or Improves thereon, and who contracts for the projects with a
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