PMT17-00345 City of Menifee Permit No.: PMT17-00345
29714 HAUN RD. Type: Residential Mechanical
<ACCEL/-> MENIFEE, CA 92586
MENIFEE Date Issued: 0 210 6/2 01 7
PERMIT
Site Address: 29072 DESERT HILLS DR, MENIFEE, CA Parcel Number: 338-052-013
92586 Construction Cost: $6,425.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT CARRIER 2.5 TON, 14 SEER, SINGLE STAGE A/C, 60,000 BTU FURNACE
Work:
Diner Contractor
DON OLSON MONK'S AIR CONDITIONING
29072 DESERT HILLS DR P O BOX 128
MENIFEE, CA 92586 SUN CITY,CA 92586
Applicant Phone: 9516794502
GARY MONK License Number.912194
MONK'S AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description Amount($)
Forced-Air or Gravity-Type.Furnace or Bumer 1 149.00
Air Handling/Condensing Units SFR 1 133.00
Building Permit Issuance1 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 staled,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 ❑ 1 am exempt from licensure under the Contractors'State License Law for t
following reason:
I hereby affirm under penalty or perjury that I am licensed under provisions of
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
Professions Code Inse is in full force and eff t which I must have resided for at least one year prior to completion
License Class_ Licens No. 2-1 improvements covered by this permit,I cannot legally sell a structure that I he
ices�-� - Signatu built as an owner-building if it has not been constructed in its entirety by licens
Ex
P contractors. I understand that a copy of the applicable law, Section 7044 of t
WORKERS'COMPENSATION DECLARATION - Business and Professions Code,is available upon request when this application
submitted or at the following Website:
❑ I hereby affirm under penalty of perjury one of the following declarations: http,/Avww leainfo ca aov/plaw.html.
1 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 _ Dale
Section 3700 of the Labor Code,for the performance of work for which this
permit is issued. Property Owner orAulhorized Agent
Policy# ❑.By my Signature below, 1 certify to each of the following: I am the prope
owner or authorized to act on the property owner's behalf. I have read 0
I have and will maintain workers' compensation insurance, as required is application and the information I have provided is correct. I agree to coml
section issu of the Labor Code, for the performance of the work for which this with all applicable city and county ordinances and state laws relating to buildi
permit is issued.Myworrke�rs'compensation insurance carrier and policy number are: construction.I authorize representatives of this city or county to enter the abo%
Carrier r _ G identified property for the inspection purposes.
Policy#12-7Lo- I2 Expires D'— — !' Date
Properly Owner or Authorized Agent 'f�
(This section need not be completed If the permit is for City Business License# O !15 7 uQ
one-hundred dollars($100)or less)
HAZARDOUS MATERIAL DECLARATION
I certify that in the performance of the work for which this permit is issued,I
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
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 f hW mply with those provisions. /I ❑YES 7NO
Appli ant• Date; Ly I 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(SCAOMD)?See permitting checkli
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines '
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES <NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed ro osed building or modified facility he within 1000 feet of the out
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounds ofa school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES VNO
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&Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mate Ire ord
OWNER BUILDER DECLARATIONS DYES NO Date
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the reasons)indicated below by the checkmark(s)I have placed PRO OAll[_ZO AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5.Business and Professions Code: EPA RENOVATION REPAIR AND PAINTING(RRP1
Any city or county that requires a permit to construct, alter, improve, demolish,
or repair any structure, prior to its issuance, also requires the applicant for the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
permit to file a signed statement that ns or she hai ter 9 ( pursuant to the receiving compensation for most work that disturbs paint in a pre-1978
provisions of the Contractor's State license Law(Chapter 9 (commencing with residence or childcare facility to be RRP-certified firms and comply with
Section 70mm)of Division 3 of .and the b and cir t Professions Code) m that he or
she is exempt from.licensure.and the basis fdr the alleged exemption. Any required practices.This includes rental property owners and property
Violation of Section 7031.5 by any Applicant fora 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:
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 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 ❑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).
❑ 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 Contractor's License Law does not apply td an owner of a property -
Wenifee
DATE 2 " PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION -O ELECTRICAL MECHANICAL
O NEW C PLUMBING C RE-ROOF-NUMBER OF SQUARES -
DESCRIPTION OF WORK ,hC 6V 0 u 2 - S-
52. Srl i 5I �'c (uC l�Ti ILLLY-Z CC
Lon�:��c�
PROJECTADDRESS Z G 72 { �D�5�'1 `LlS Dr- IL L _ Ga59t-
ASSESSOR'S PARCEL NUMBER //3 3�U� 2 O 3 LOT 10 TRACT
V OWNER NAME ((�;�; /� /�
ADDRESS/�n���lSLI l (N�-' Ia:t�. /C�( L� ecU!ralIUCA VVA ��j�C�
PHONE ( l �' J 7 �7D - `"I/.L(i EMAIL
APPUCANT NNA/MMEG2 Y �y
ADDRESS ��1cVIl� W M UM1 I� Mt I �t a 05
R
PHONErq ) ( '767-4S` ' 2 J� EMAILYYIpnKSaIM- D 1Y1LZ.d - Cbm
CONTRACTOR'S NAME C 0 Y 1 yl U- 4
OWNER BUILDER? O YES NO
BUSINESS NAME OnIC5Con&4-fonlrlan
34
ADDRESS///�S! J I �� ( "/25
PHONE ( "! 6-74l : 452 _, IEMAIL monlcg�tr a'� mom/- - • �►y-%
/0
CONTRACTOR'S STATE LIC NUMBER C1 I Z I-l/]`l LICENSE CLASSIFICATION I�ZO
VALUATION$ 2J
SQ FT % Z L s4 FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DM RIBLMON CRYOF MENIFEE BUSINESS LICENSE NUMBER
SUR:DING PANNING EN INEERING FIRE GREEN VV- SMIP
INVOICE I PAID AMOUNT O CASH 0 CHECK# O CREDR CARD VISA/MC
AMOUNT
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK* O CREDITCARD VLSWMC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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