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PMT17-01436 City of Menifee Permit No.: PMT17-01436 29714 HAUN RD. <A-CCEL/!? MENIFEE,CA 92586 Type: Residential Mechanical ""....."'"'" MENIFEE Date Issued: 05/04/2017 PERMIT Site Address: 26761 CALLE EMILIANO, MENIFEE, CA Parcel Number: 330-291-027 92585 Construction Cost: $6,392.65 Existing Use: Proposed Use: Description of HVAC CHANGE OUT CARRIER 3.0 TON 14 SEER,80%AFU, R410A,SINGLE STAGE SPLIT A/C Work: SYSTEM Owner Contractor DEE BYERGO MONKS AIR CONDITIONING 26761 CALLE EMILIANO P O BOX 128 MENIFEE, CA 92565 SUN CITY, CA 92586 Applicant Phone:9516794502 GARY MONK License Number: 912194 MONKS AIR CONDITIONING P O BOX 128 SUN CITY, CA 92586 Fee Description qtv Amount ISI 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 slated,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 ❑ [am exempt from Ilcensure 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 eff •t which I must have resided for at least one year prior to completion License Class _Licens No. Zl improvements covered by this permit,I cannot legally sell a structure that I ha Expires 3-31-i R' Signalu built as an owner-building if it has not been constructed In its entirety by licens 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 applicatior submitted or at the following Web site: ❑ I hereby si under penalty of perjury one the following declarations:workers' hftp:/Avww.leginfo.ca.gov/mlaw.htmi I have and willll maintain a certificate of consentt 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 wbrk 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 1 have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read ti 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 carder and policy number are: with all applicable city and county ordinances and state laws relating to build! 1 construction.I authorize representatives of this city or County to enter the abor Car der identified property for the inspection purposes. Policy#/2-7b0- I2 Expires_ �S— — ('.� Date Property Owner or Authorized Agent (This section need not be completed If the permit is for C' Business License# -79 one-hundred dollars($100)or less) dY O J 5 I certify that in the performance of the work for which this permit is Issued,I HAZARDOUS MATERIAL DECLARATION shall not emolov 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 hwi mply with those provisions. ❑YESNO Appli ant* Date; 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 building or modified facility be within 1000 feet of the out DAMAGES AS PROVIDED FOR IIN SECTION 3706 OF THE bounds ofa school? LABOR CODE, INTEREST,AND ATTORNEYS FEES � DYES ,ZNO 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 ahecklist.I understand my requirements under the State of agency for the performance of the work which this,pernit is issued (Section California Heald Safety Cyy' e,Section 25505 and 25534 concerning 3097 Civil Code) hazardous mate Ire orit OWNER BUILDER DECLARATIONS ❑YES NO 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 PROk-RTYr0d1Nk_QA 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 fRRP) 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•Businpss and Professions Code)or that he or residence or childcare facility to be RRP-certified firths and comply with she is exempt from.Ilcensure.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 EPRs Renovation Program visit: ❑ I, as owner of the roe www.epa.gov/lead or contact the National Lead Information Center al property,rty, 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 sWcture 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 O 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). Firth Certification Nb.: ❑ I, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Firm is required for this project bemuse: contactors 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 0 Menifee AA DATE 7� I �I PERMIT/PLAN.CHECKNUMBER TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOUTION -O ELECTRICAL XMECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK PrC O Ld 3.. L 11 Seer �C E�° A��- it Lz c ,e �/c s PROJECTADDRESS ASSESSOR'S PARCEL NUMBER 33D Z 'N O Z LOT Z TRACT OWNERNAME Def>2 L f } ADDRESS /� PHONE `IJ/ J 4� �� LI% Z 1,EMAIL APPUCANT NAME . . /G L V. ADDRESS �J Q / G,J\�T/J�TO �1M U I {r M l..>f I I rZ."l.. CA PHONE (`7JF J IP (/��' 7 S� EMAIIIYaUt1KSCL t r iT'10.La GUYYI CONTRACTOR'S NAME 1.1 M O OWNER BUILDER? C YES NO BUSINESS NAME n G 314 ADDRESS /� � I "/25 PHONE N? CO !�i� `T. xnJZ IEMAIL mon lcsa t r aD eqeyk�-L • C-D►'n CONTRACTOR'S STATE LIIC NUMBER �!I2 -/`Y LICENSE CLASSIFICATION VALUATION$ 6,392 • S SQ FT Z 3 L SO FT APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION CRY OF MENIFEE BUSINESS UCENSE NUMBER BURRING PLANNING ENGr1MEERING IRE GREEN I SMIP AMOUNTINVOICE 6 ° PAID AMOUNT 0C/SX OCXECK# OCREDR CARD VISNMC PLAN CHECK FEES PAID AMOUNT 0 CASH O CHECK# O CREDIT CARD VIWMC OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Merifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 D w f7 N t°O V 1pn W Fp+ -nn "n^ D D m C .�. xLl o M. N ^ v<i N m 3 v D o o 74 7 z o n ? 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