PMT16-02986 City of Menifee Permit No.: PMT16-02986
29714 HAUN RD. Type: Residential Mechanical
<A—CCELY;�.' MENIFEE,CA 92586
MENIFEE Date Issued: 0910812016
P E R M I T
Site Address: 28436 SUN CITY BLVD, MENIFEE,CA Parcel Number: 335-352-002
92586 Construction Cost: $7,685.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT AMERICAN STANDARD 3.5 TON, 14 SEER, OVER/UNDER PKG HEAT PUMP
Work;
Owner Contractor
TEDDY LOVE MONK'S AIR CONDITIONING
28436 SUN CITY BLVD P 0 BOX 128
MENIFEE, CA 92586 SUN CITY, CA 92586
Applicant Phone: 9516794502
GARY MONK License Number: 912194
MONK'S AIR CONDITIONING
P 0 BOX 128
SUN CITY, CA 92586
Fee Description ON Amount
Forced-Air or Gravity-Type Furnace or Burner 1 149.00
Air Handling/Condensing Units SIFIR 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 OF 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 BIdgPermit-Ternplate.rpt Page I of 1
City Of Menifee
LICENSED DECLARATION 13 1 am exempt from ficensure under the Contractors'State License Law for U
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing with secUcn 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence
Professions Code ro license I.s in full force and eff which I must have resided for at least one year prior to completion
License Class. ,Zia Licens No. 2_1QL/ improvements covered by this permit,I cannot legally sell a structure that I ha
_R' signatuAC: 4�� built as an owner-building if it has not been consWeted in its entirety by ficens,
Expires 3--aL 1 3 — — contractors. I understand that a copy of the applicable law,Section 7044 of V
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application
submitted or at the following Web-site:
0 1 hereby aiftirm'under penalty of pedury one of the following declarations: hth): leaImro.ca.qov/calavv.htmI.
I have and will maintain a certificate of consent of self-insure for workers'
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 or Authorized Agent
Policy# 0 By my Signature below, I certify to each of the following: I am the prope
�5( I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owners behalf. I have read it
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 comi
permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws retailing to build!
construction.I authmize representatives of this cittr or county to enter the abo%
Carrier identified property for the inspection purposes.
Policy#12 1'2— Expires 6— 1 Property Owner or Authorized Agent Date
(one-hundred dollars($100)or less) -79
This section need not be completed if the permit is for City Business License# 055(o
4 1 certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not emplo 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 3700 of the Labor amounts
. Fecified on the Hazardous Materials Information Guide?
Code.I shall fqphi%M�fcimply with those provisions. DYES X NO
Appli(ant,%� Date; Will the Intended.use of the building by the applicant or future building
�1� occupant require a permit for the construction or modification from South
ZNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checkli
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 out
DAMAGES AS PROVIDED FORAN SECTION 3706 OF. THE boundaN f a school')
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES NO
CONSTRUCTION LENDING AGENC 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 A Safety C a.Section 25505 and 25534 conceming
3097 Civil Code) hazardous mate I re, ort,
DYES rNO -7
OWNER BUILDER DECLARATIONS X1
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 PRO OAkpl(AUTHORIZED AGENT
next to the applicable Itern(s)(Section 7031.5. Business and Professions Code:
Any city or county that requires a peardt to construct,alter,improve,demolish, EPA RENOVATION,REPAIR AND PAINTING flRRPI
or repair any structure, prior to its issuatice, 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-1 978
Section 7000)of Division 3 of the-Businjass and Professions Code)or that he or residence or childcare facility to be RRP-cerfified firms and comply'Adth
she is exempt kom.lioensure.and the basis ficir the alleged exemption. Any required practices.This includes rental property owners and property
Violation of Section 7031 65 by any Applipant foris permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500-y employees.For more information about EPA's Renovation Program visit:
www.epa.gov/lead or contact the National Lead Information Center at
0 1, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(5323).
compensation,will do( )all of or( 11 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 El An EPA Lead-Safe Certified Renovator will be responsible for this projec
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 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)6
0 1, as owner of the property a*n exclusively contracting with licensed 0 No EPA Lead-Safe Certified Firm is required for this project because:
cont-actors to construct the project(Section 7044, Business and Professions
Code:The Contractor's License Law does not apply td an owner of a property
who builds or improves thereon, and who contracts for the projects With a
Menifee
DATE CL -7�1 �,o PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMER CIAL )(RESIDENTIAL OMUL71-FAMILY OMOBILEHOME OPOOLISPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOUTION OELECTRICAL 1KMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES.
DESCRIPTION OF WORK -"6(- nuf hrqeLi( a-,Ii �5jLndard
�-Dn 1, 14�Cj 5� -w, r)� J�z om L'�- LO, Len�7t 1)uz�)
PROJEcTADDRESS r. i-j k,
ASSESSOR'S PARCEL NUMBER -)LOT TRACT
OWNER NAME T�' d/'YL/ Vf,
ADDRESS2-R q Z) 6 4 b /v-d WdiWo 1, rA (TZ5L I,,,
PHONE ZO J -JEMAIL
APPLICANTNAME a�LY-V 1,K
ADDRESS 305-�)Q M Q IfA-n ;Z d F M cA
PHONE (q5l) (C;7q-Lf 502- EMAILn-j0nKS0ir9D0rrw:1A - cbm
CONTRACTOFeS NAME aLr-y M QrkK OWNER BUILDER? 0 YES kO
BUSINESSNAME MnrjV-� ACW Cbodihor) �ria
L4- 'p- C125 9 q
ADDRESS MI )rr--j-e4n -k0 NA 6
PHONE6950 6EM— 4502- EMAIL M6r)1C-SaIrZ@ry,1C6-L Czrn
CONTRACTOR'S STATE LIC NUMBER C112- IqL4 LICENSE CLASSIFICATION C2_0
r�( ( SO FT C'\ LSQFT
VALUATION$ i �B5
APPLICAWS SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICEN$E NUMI3hK
BUILDING PLANNING ENGINEERING FIRE GREEN smip 7
INVOICE PAIDAMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
AMOUNT 1�4�4, 111 1 1 1
PLAN CHECK FELS PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISAIMC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92585 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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