PMT17-01708 City of Menifee Permit No.: PMT17-01708
29714 HAUN RD. Type: Residential Mechanical
<A-CCEL/-> MENIFEE,CA 92586
MENIFEE Date Issued: 05/31/2017
PERMIT
Site Address: 27192 CORONADO WAY, MENIFEE, CA Parcel Number: 336-210-005
92586 Construction Cost: $4,700.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT,CARRIER 2.5 TON, 14.0 SEER, 122 EER, R410A,SINGLE STAGE, SPLIT A/C
Work: SYSTEM
Owner Contractor
JUNE RUBIN MONKS AIR CONDITIONING
27192 CORONADO WAY P 0 BOX 128
MENIFEE, CA 92586 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 Qty, 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 carded 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_Templaterpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure under the Contractom'State License Law forth
I hereby affirm under penalty or perjury that I am Ilceris 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 i•
Professions Code license is in full force and eft which I must have resided for at least one year prior to completion c
License Class. Ucens No. 2 improvements covered by this permit, I cannot legally sell a structure that 1 haw
Expires3-3)-1 R Signalu built as an owner-building if it has not been constructed in Its entirety by license
contractors. I understand that a copy of the applicable law, Section 7044 of thi
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application is
submitted or at the following Web site:
❑ I hereby affirm under penalty of perjury one the(allowing declarations: htto://www.leciinfo.ca.aovlcalawhtml.
I have and will maintain a certificate of consentt of self-insure for workers'
compensation,issued by the Director of Industrial Relati ns as provided for by Date
Section 3700 of the Labor Code, for the performance f work for which this
permit is issued. Property Owner orAuthoriied Agent
s
Policy# ❑ By my Signature below, I certify to each of the following: I am the propeM
I have and will maintain workers' compensation Ins irance, as required by owner or authorized to act on the property owner's behalf. I have read thi:
section 3700 of the Labor Code, for the performance of a work for which this application and the information I have provided is correct. I agree to compq
permit is issued.My workers'compensation insurance cardei and policy number are: with all applicable city andcounty ordinances and state laws relating to bulldlnf
C� construction.I authorize representatives of this city or county to enter the above
Cartier �[ identified property for the 19'spection purposes.
Policy 2. Expires I I Date
Property Owner orAuthodzedd Agent /� may/
`2 56 —/ L�
(This section need not be completed if the permit is for CI Business License# l one-hundred dollars($100)or less) City �
Asall
I certify that in the performance of the work for which is permit is issued,I HAZARDOUS MATE;RIAL DECLARATION
not employ any persons in any manner so as tq ecome subject to the Will the applicant or future!building occupant handle hazardous material or a
workers'compensation Taws of California, and agree th t if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Sect on 3700 of the Labor amounts Fecified on the Hazardous Materials Information Guide?
Code,I shall wit#mply with tho..e provisions. ❑YES NO
Date;Appb n 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 SECUI RE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER Try CRIMINAL PENALTIES AND ❑YES <NO
CIVIL FINES UP TO ONE HUNDRED THOUISANO DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounce ofaschool?
LABOR CODE,INTEREST,AND ATTORNEYS FEES ❑YES ZNa.
CONSTRUCTION LENDING AGENCY
I have read the HazardousiMatedal 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 P e,Section 25505 and 25534 concerning
3097 Civil Code) I hazardous mate Ire orti• .
OWNER BUILDER DECLARATIONS ❑YES NO
I hereby affirm under penalty,of perjury that I am exempt from the Contractor's Data.
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROk-RT<0dNk94 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, a0el, improve, demolish, EPA RENOVATION REPAIR AND PAINTING(RRP,
or repair any structure, prior to its issuance, also requiresthe 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 ost 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 faciliy to be RRP-certified firths and comply with
she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit spbleots 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, or my employees with wages as their sole w rw.epa.govAead or contact the National Lead Information Center at
compensation, will do( )all of or( )porting of the work„and the structure is 1-Bm0-424-LEAD(5323).
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
who, through employees' or personal effort,; builds or improves the property, An EPA Lead-Safe Certified Renovator will be responsible for this project
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 of improved for the Finn Certification o.:
purpose of sale). N
❑ 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 to an owner of a property
who builds or Improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Law). If your project Goes not comply with EPA RRP rule please fill out the RRP
B!jILDING & S���FC-:-IVPERI��-ITI/PL-ANC.HE--KAPPLI.CATION .
Menifee
DATE `JL�� I� PERMIT/PLANCHECKNUMBER
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLRION -O ELECTRICAL MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK ou4 (L h-L( L "5 4 L U, I -b S-
LEL
12,2 e0, ELI1Cct S LICce S Lf /�
PROJECTADDRESS 2 1
ASSESSOR'S PARCEL NUMBER 3'36 ZVO L�c�s'! LOT- TRACT `�3 3
OWNER NAME ( /'� , �-bi�1 A /�
ADDRESS rr / 1( f c)(L 1 �a I� .y)l "(7 (zi
PHONE (cl, L 1 2 EMAIL
APPLICANT NAME I� r Ly l L Y,
ADDRESS//��JIJ\J/�JCA Lq�Z5N
-7O/� M UMI I�
PHONE t ` 5l J (P ("q-L 502 EMAILrrU>tIKSA I r 0 @ rra:d • cbrn
U
CONTRACTOR'S NAME Q-r Y M OCv1 L O_WNER BUILDER? O YES NO
BUSINESS NAME 1 I CDY�cfi or) n
ADDRESS!/� /�//� rr
PHONE ( IRM 6, !'mil- 4509- /]_� /EMAIL mcnl�sGtr � rna-+-�- �►n
CONTRACTOR'S STATE LIC NUMBER c I Z I-/"Y LICENSE CLASSIFICATION zt���
VALUATION$ SQ FT r� L SQ FT
rDEPEN
A(UIU ��LMON 00 CRY OF MENIFEE BUSINESS UCENSE NUMBER
ENGINEERING HRE GREEN • SMIP
PAID AMOUNT O CASH O CHECK 6 O CREDR CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDIT CARD VIWMC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department29714 Houn Rd. Menifee, CA 92586 951-6 72-677 7
www.cityc finenifee.us Inspection Request Line 951-246-6213
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