PMT17-00399 City of Menifee Permit No.: PMT17-00399
29714 HAUN RD.
<--ACCELh� MENIFEE, CA 92586 Type: Residential Mechanical
1. "'" MENIFEE Date Issued: 02/13/2017
PERMIT
Site Address: 27810 BLAZE LN, MENIFEE,CA 92586 Parcel Number: 331AOO-007
Construction Cost: $6,450.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, CARRIER 3.0 TON, 14 SEER, SINGLE STAGE SPLIT A/C,70K BTU FURNACE
Work:
Owner Contractor
ELSIE PATRICK MONK'S AIR CONDITIONING
27810 BLAZE LN 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 QQtt( Amount isl
Forced-Air or Gravity-Type Furnace or Bumer 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
$324.10
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Men'rfee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Permit Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from licensure under the Contractors'State License Law fort
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that,except for my personal residence
Professions Code license is in full force and eft t Z� L which I must have resided for at least one year pdor to completion
License Class (i Ucens No. improvements covered by this permit,I cannot legally sell a structure that I he
Expires3�3 Signatu built as an owner-building if it has not been constructed in its entirety by Iicens
contractors. 1 understand that a copy of the applicable law, Section 7044 of t
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application
submitted or at the following Websfte:
❑ hereby affirm under penalty of perjury one of the following declarations: http:/Miww.leainfo.ca.cov/dlaw.html.
I have and will maintain a certificate of consent of self-insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the prope
'$( 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 9
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'compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to builds
' construction.I authorize representatives of this city or county to enter the atim
Carrier c- identified property for the inspection purposes.
Policy#12-7 )b0- / 2 Expires 6. Date
PropertyOwner or Authorized Agent F,—
(This section need not be completed if the permit is for 03 ✓(clg
one-hundred dollars($100)or less) City Business License#
4 1 certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
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 edfied on the Hazardous Materials Information Guide?
Code,I shall f wi mply with those provisions. DYES NO
Appli of Dbte; 2- W�1 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 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 bullding or modified facility be within 1000 feet of the out
DAMAGES AS PROVIDED FOR iN SECTION 3706 OF THE bounds of a school?
LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES RNO .
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 C e,Section 25505 and 25534 conceming
3097 Civil Code) hazardous mate I re orti 4
OWNER BUILDER DECLARATIONS ❑YES NO , —
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Dete2—L]IB 1�
License Law for the reasons)indicated below by the checkmark(s)I have placed PRO O N 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(_RRP)
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 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-1978
Section 7000)of Division 3 of the-Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firths and comply with
she is exempt from Toensure.and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 703:1.5 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:
❑ I, as owner of the property, www.epa.govllead or contact the National Lead Information Center at
p pert, 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.(Secton 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 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 purpose of sale). Finn Certification No.:
❑ 1, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Firm Is required for this project because:
contactors to construct the project(Section 7044,Business and Professions -
Code:The Contractors License Law does not apply tdan owner of a property
who builds or improves thereon, and who contracts for the projects with a
--v PERIV11IT/PLAN' CHECK APPLICATION
Menifee
DATE — tf/ PERMIT/PLAN CHECK NUMBER �®
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOUSPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION -O ELECTRICAL XMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK ,4L 3 n I SCE
3i ry 1,e, �1C CL G
PROJECT ADDRESS �)r�� `� ���! �
ASSESSOR'S PARCEL NUMBER 33 oD 00 - LOT TRACT 2,3 3 1 0
OWNERNAME
ADDRESS
PHONE l 72- IV J EMAIL
APPLICANT NAME
Y' .�y p4 n' ,/��./"� Q
ADDRESS /�]cl'>J�J�}�/� (M� UMI �I'l� f�� . M� � � `�� CA C125"
PHONE (77! (/7�� 1 SU/�y� EMAILn-lo 1KSU.1 rIV rra1 A • COrn
CONTRACTOR'S NAME lei a rl V I D .� J OWNER BUILDER? O YES NO
BUSINESS NAME / CD►1C� 'or) i n G
ADDRESS E` (Af CA vl25
PHONE (q51� t21� 450' 9- /]l EMAIL monkSctrc� r*zaa ! • Go►►'�
CONTRACTOR'S STATE LIC NUMBER C1121 `7 LICENSE CLASSIFICATION cz
VALUATION$ J� cC:) SQFT LSO FT
APPUCANTS SIGNATURE DATE
DEPARTMENT DISTRIBUTION UIY OF MENIFEE BUSRV6S UCENSE NUMBER
BUILDING PLANNING FNGIgN�EEPJNG RRE GREEN SMIP
AMOUNTINVOICE
'I� PAID AMOUNT OCASH OCHECK# OCREDRCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT O� OCHECK# 0CREDR CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
Q
m w m
C .ter X
n _N Pf v v D D O
,,, ' 3 m »• m n d n n m io D o m d
a o m c d a m o !? N o
F N N r 7 O io n y 3
m d = v
n D n r N n 0Q 0
- » O r
c p 0 O y� = O 7 O. D
;w Z
0
n a .COi O C. o
m m N
m pz "YN � a O r N
n O S
0 o w
3 0 3 00 r
� w n
r
CD m p c
T� 00 vOi Vw
CD
/ [U
iv
O U 3 W O 00 Oi A N QCD O
O O O = a
� m 3 s f0 3 'm oa3 o m m oL m w
C
w N O N A O A
A Q Q
v
w C m fD lD
Z N ry N 91 j O 1D
O
N
o n ^ m
Z < D N O Q
n x �
N z ^O Q
r.
N 5 p 0 y O m
PWTI-7 00 "27`71
T r r
n m 'n m
v w m
Trw
Z Z �Nw nn33 : m H e m
x s —. i' nv m W O
� C a T
m n O
w m a
m � ° w n
n N oD 9 9 0 � N r <
u O ID � m a 'm � =`w c n = ao f � W O• Ip N
9 O ID E C O ? o :E C N
= C E a N
'm 'm 7 -,
m R >
o O m r3
_ � c
o Ip a � 3 3 m, — °
� w m3 = O; D
0 3 C 3
s OOa T S i n n a o m o ° m n a= w C D
F N °
,n" m 1X oEo
o 6w a 3 n •c
_ N A
oo vi w m a Fo A E n .. • 'o < w
El
EL o
V ID w m' 6 V R W
N m o
. n
Q: o m 0 3 is
N 3 m
D z
d _
O.C d m m
i {mil a v a 3 C O
] O x m x m
N � 6
D Q
va a•'^. � n mZ
_ �
= N � Y F F•
S f1
Y O N
v
= m W N
o u' m
b y� O�
N fD ma 03 D ° O D m
'n
m c tp N .�+ n w n m d c �' » n £ N N I nCR D S d w m
m 3 2
Z 3 w ZO O O o 7 p d 2 ? n p
0 '° o °»' vim^ 'o"< 'y o 3 0 3 eCi n 3
Z w va' y m '�° v m Z ry N S O T
vi i.0i a w w, oa 1° N o < oa w Z .Z a D
a
n N w d o d n » T `c' O O d w
Q.
n 3 u w lOi R O
N
u o - S10 N — »— a. 'o v 9, O. m
C. j N „ . m n w <
O o
m vi C r
rl E m o o 'c o A
o n z w o a v 0
o p =
0 az
3
_ 0 3
T
l O m N
0
N N o
ti F 'A N n m sm 3 o '^
r3 w to O O - uAi o o
>
m o 0 0 0 =
o5, 3
b W w a ? p o. m 4J oa
Vo
0 o L m e a j o
w 'o: — - 5 m ry pv�`
w
> = a
m nip
m o °EL
o S o
r;
m > m _
o
m o o = m
rp
,d. m
m a � o N
O O n
O N u S m T
w
r d
p m d M O
� o N
w VI N