PMT16-04235 City of Menifee Permit No. PMT16-04235
29714 HAUN RD. Type: Residential Mechanical
<A-CCF-CA-> MENIFEE,CA 92586
MENIFEE Date Issued: 12/1912016
P E R M I T
Site Address: 27238 GRANADA WAY, MENIFEE. CA Parcel Number: 336-011-002
92586 Construction Cost: $7,610.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT,AMERICAN STANDARD 3.0 TON, 14.0 SEER, OVER UNDER PACKAGE HEAT
Work: PUMP
Owner Contractor
GARY MEYER MONKS AIR CONDITIONING
27238 GRANADA WAY 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 126
SUN CITY, CA 92586
Fee Description Qtv Amount($1
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 0 lam exempt from ficansure under the Contractors'State License Law fort
I hereby affirm under penalty or perjury 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 acknowledge that, except for my personal residence
ense is in full force a d ff t
Professions Code 2ndplil-C which I must have resided for at least one year prior to completion
License class Licensff No. 2-1 q improvements covered by this permit I cannot legally sell a structure that I ha
built as an owner-building If it has not been constructed in its entirety by ficens
Explres3_5 I—/ Signatu contractors, 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
D I hereby affirm under penalty of perjury one of the following declarations, submitted or at the following Web site:
I have and will maintain a cartificate of consent of self-insure for workers; hftp legInfo.ca.gov/c�Iaw.htrnI
compensation,issued by the Directo,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 orAuthofized Agent
Policy# 0.By my Signature below, I certify to each of the following, 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 V
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 coml
permit is Issued.My workers'compensaton insurance carrier and policy number are: i all applicable city and county ordinances and state laws relating to build!
construction.I authorize representatives of this city or county to enter the abox
Carrier identified property for the inspection purposes.
Policy# 12—700— 1'2— Expires 4761- 1 -17 Property Owner orAuthorized Agent Date
(This section need not be completed If the permit is for -79
one-hundred dollars($100)or less) City Business Ucense# 0:305to
-4 1 certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not emi3lo 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 s ecified on the Hazardous Materials Information Guide?
Code,I shall f9Plhwiff#mpIy with those provisions. 11YES'ZO
Appli(aQ�>( � Date; Will the intended.use of the building by the applicant or future building
A-,/ occupant require a permit for the construction or modification from South
tNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting chackli
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES 0
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS _KN
($11 OO,OOD), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the out
DAMAGES AS PROVIDED FOR'iN SECTION 3706 OF. THE boundaVof a 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 He:atllth A*5afe ' a,Section 25505 and 25534 concerning
us m c�
3097 Civil Code) hazardous mate I re rt A!
OWNER BUILDER DECLARATIONS DYES NO
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Z07L� Date
License Law for the reason(s)indicated below by the checkmark(s)I have placed P k94 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 JRB_Pl
or repair any structure, prior to its issuarrice, 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-Busings 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 f6r the alleged exemption. Any required practices.This includes rental property owners and property
Violation of Section 703'1.5 by any Applicant lor�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-y employees.For more information about EPA's Renovation Program Visit:
www.epa.gov/lead or contact the National Lead Information Center at
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( %,porting of the work, and the tructure 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 [3 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 provir.g that it was not built or improved for the
purpose of sale). Finn Certification No.:
11 1, as owner of the property an exclusively contracting with licensed 0 No EPA Lead-Safe Certified Firm is required for this project because:
cant,actors to construct the project(Section 7044,Business and Professions
Code:The Contractor's License Law does not apply tcr an owner of a property
who builds or improves thereon, and who contracts for the projects with a
Menifee
DATE 12-/1 z PERMIT/PLANCHE
TYPE: 0 COMMERCIAL �K RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: 0 ADDITION 0 ALTERATION 0 DEMOLITION -0 ELECTRICAL XMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK +NhC- oil Aiw n cojl� (�;�nnJLAI
AD seqz2 C)\,i7er IA,nde, y- r�o ( i�on.e klea:f nlxxyu9 ,
Q 2-5k
PROJECTADDRESS Z—/2—---5 R 0-r(-Lnao, a - i K-)�W Mej -[-�u L4
ASSESSOR'S PARCEL NUMBER 33& 0 11 - b02 :-D IOT TRACT -3CD-72—
OWNER NAME (U�J --e—)Af r
ADDRESS IU-n -S LJO024
PHONE (q5/ )6�'7CI— qcS-L) 7 EMAIL
APPLICANINAME
ADDRESSW 0 P., CA C)�N
PHONE �;7q�q502 EMAILn, -0,t.1KSCtirtD@rrn�A . rh#�
coNTRACrOWSNAME aw QWNERBUILDER? OYES
Bt Ina
ADDRESS ��0530 MIJEC11tin Rd c�A
-76
PHONE (CIM 6; �- 4502- EMAIL rY10nV-SzZ*Ir A Pyk4k;LL C-D
CONTRACTOR'S STATE LIC NUMBER C?12-1?L1 LICENSE CLASSIFICATION C2-c)
VALUATION$ D sQ FT LSQFT D.
APPUCANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CrTY OF MENIFEE BUSINESS UaNSE NUMBER
BUILDING PLANNING ENGINEERING FfRE I GREEN SMIP I I
INVOICE PAIDAMOUNT OCREDITCARD VISA/MC
MOU
I 1 0 CASH 0 CHECK#
:A OUNT -- -
PLAN CHECK FZES PAIDAMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VLCA/MC
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 92586 951-672-6777
www.city,ofmenfee,us Inspection Request Line 951-246-6213
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