PMT17-02321 City of Menifee Permit No.: PMT17-02321
29714 HAUN RD.
C-�CCEL.A? MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 0 710 612 01 7
PERMIT
Site Address: 26566 CALLE GREGORIO, MENIFEE,CA Parcel Number: 330-280-013
92585 Construction Cost: $4,600.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, CARRRIER 3.0 TON, 14 SEER, R410A SINGLE A/C
Work:
Owner Contractor
LORRAINE LAGASSE MONKS AIR CONDITIONING
26566 CALLE GREGORIO P 0 BOX 128
MENIFEE, CA 92585 SUN CITY, CA 92586
Applicant Phone:9516794502
GARY MONK License Number:912194
MONKS AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description Q1 Amount I$
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 6.65
$167.66
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.
M Bldg_Pennil_Template.rpl Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure under the Conuadom'State License Law for If
following reason:
I hereby affirm under penalty or perjury that I am licensed under provisions of
Chapter 9(commencing with section 7000)of Divisionn 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 which I must have resided for at least one year prior to completion
License Class _Lfcens No. I2_1 improvements covered by this permit,I cannot legally sell a structure that I hat
Expires-2>-3 i_ Signatu built as an owner-building if it has not been constructed in its entirety by licensr
contactors. I understand tha,a copy of the applicable law.Section 7044 of ti
WORKERS'COMPENSATION DECLARATION Business and Professions Code,Is available upon request when this application
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: htto:IMvnv leginfo.ca.aov/ralaw.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 wdrk for which this
permit is issued. Property Owner or Authorized Agent
Policy# ❑ By my Signature below, I certil';to each of the following: I am the proper
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 th
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 comp
permit is issued.My workers'compensation insurance carder and policy number are: with all applicable city and county ordinances and state laws relating to buildir
C construction.I authorize representatives of this city or county to enter the abov
Carrier F identified property for the inspection purposes.
Policy# Expires �— I Date
Property Owner or Authorized Agent .
(This section need not be completed if the permit is for City Business License# 035079
one-hundred dollars($100)or less)
14 I 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 9 1 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. �/ ❑YES amounts
2' /Appli ant• Date; j 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 Distddt(SCAQMD)?See permitting checklis
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 100D feet of the oute
DAMAGES AS PROVIDED FOR IIN SECTION 3706 OF THE bounds of school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES , NO
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 Califomia Health Safety.C e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mate Ire orti
OWNER BUILDER DECLARATIONS DYES NO Z�I I
I hereby affirm under penalty of perjury that I am exempt from the Contractors Date I
License Law for the reason(s)indicated below by the checkmark(s)I have placed PRO 6AAE,014 AUTHORIZED AGENT
next to the applicable Item(s)(Section 7031.5. Business and Professions Code:
Any city or county that requires a permit fin construct, alter,improve, demolish, EPA RENOVATION.REPAIR AND PAINTING IRRPI
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 firms and comply with
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 703;1.5 by any Applicant fora permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civic penalty of not more than($500).) employees.For more Information about EPA's Renovation Program visit:
as owner the roe www.epa.gov/lead or contact the National Lead Information Center at
❑ p p rty, or my employees with wages as their sole 1-800424-LEAD(5323).
compensation,will do( )all of or( )porting of the work, and the structure is
not intended or offered for safe.(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 project
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 Finn 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:
contactors to construct the project(Section 7044, Business and Professions
Code:The Contractor's License Law does not apply IS an owner of a property
who builds or improves thereon, and who contracts for the orofects with a
t
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
MTI - 0 7024
DATE Z �t PERMIT/PLAN CHECK-NUMBER
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION b DEMOLITION- O ELECTRICAL MECHANICAL
O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES /1
DESCRIPTION OF WORK P(C- CbaDW C)t, D
l Ji >-/G
PROJECTADDRESS 56(�) Ca. Lc- Crr-e rLC) M I CA 25S
ASSESSOR'S PARCEL NUMBER 3'30 7,?0 0 1 -3- LOT VS— TRACT Z k %A 1
OWNER NAME S
ADDRESS as
PHONE EMAIL
APPLICANT NAME r
ADDRESS /3�c0,l5/3-70/] ML u Mtn`tn i Eet CA q`-'"RAF
PHONE rq5 J (. /q-L S` 02 A EMAILrnDnkSAly-� a-k5w corn
CONTRACTOR'S NAME 1.1 rY I I/I O / J OWNER BUILDER? O YES NO
BUSINESS NAME J Ir Conde on VL14
ADDRESS /� •'� I � r L•S T
PHONE (�I SI� Cp�� ��Z EMAIL mOn l-Sa)r Z h1�L • GDYYI
CONTRACTOR'S STATE LIC NUMBER q12 t9y LICENSE CLASSIFICATION C2-0
VALUATION$ q, PC ! SQ FT Z�l_ L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFFUSEONLY
DEPARTMENT DISTRIBUTIDN ® CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN a SMIP
INVOICE (^ 5j PAID AMOUNT
AMOUNT Y�.'�•� 0CASH 0CHECK# OCREDITCARD \nSVMC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER 0 YES 0 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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