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
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