PMT17-02447 City of Menifee Permit No.: PMT17-02447
29714 HAUN RD. Type: Residential Mechanical
ACCELA— MENIFEE,CA 92586
MENIFEE Date Issued:
07/1312017
PERMIT
Site Address: 26163 GOLDENWOOD ST, MENIFEE, CA Parcel Number: 335-423-032
92586 Construction Cost: $6,078.48
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT,CARRIER 3.0 TON, 14 SEER, 80%AFUE, R4109 SINGLESTAGE HEAT&A/C
Work: 70K BTU FURNACE
Owner Contractor
CINDY VINCKEL MONK'S AIR CONDITIONING
26163 GOLDENWOOD ST P O BOX 128
MENIFEE,CA 92586 SUN CITY, CA 92586
Applicant Phone:9516794502
GARY MONK License Number:912194
MONKS AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description 01t r 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 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_Permil_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from ficensure under the Contractors'State License Law for it
I hereby affirmunder 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 acrnowleuge that,except for my personal residence
Professions Code �^license Is in full force and eft which I must have resided for at least one year prior to completion
License Class_tn Licens No. Z improvements covered by this pemid,1 cannot legally sell a structure that I he,
Expires 3-N—! Signatu built as an owner-building if R has not been constructed In its entirety by ficensr
contractors. I understand that a copy of the applicable law.Section 7044 of 0
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, http:/A v .leeinfo.ca.eovlcalaw.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
peril Is Issued. Property Owner or Authorized Agent
Policy# ❑ By my Signature below, I certify to each of the fallowing:I am the proper
V_ 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
construction.I authorize representatives of this city or county to enter the abov
Carrier !� identified properly for the Inspection purposes.
Policy#'2— /n0— I Z Expires 6- 1 - 1 Date
Property Owner or Authorized Agent
(This section need not be completed if the permit is for oij�7g
one-hundred dollars($100)or less) City Business License#
I certify that in the performance of the work for which this peril 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 Califomia,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 ecified on the Hazardous Materials Information Guide?
Code,I shall f A mply with those provisions. ❑YES NO
i
App1i nt 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 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
($1 00,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outs
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounda of a school?
LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES KNO
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 A Safety C e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mate I re odi
OWNER BUILDER DECLARATIONS [I YES NO (j J/�''
1 hereby affirm under penally of perjury that I am exempt from the Contractor's Date I/` j I
License Law for the reason(s)indicated below by the checkmark(s)I have placed PRO O41N&OK 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 IRRP)
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 Contractors 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-icensure.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-disturoing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit:
www.epa.govIlead or contact the National Lead Information Center at
❑ I, as owner of the property, 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 sale.(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 Firm Certification No.:
purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed O No EPA Lead-Safe Certified Fir 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 td an owner of a property
who builds or improves thereon, and who contracts for the projects with a
ro.e., A ,..,..,.r,..4h. crate I;.e i—A Ii„norm nrn,art dncc nN with FDA PPP nda nlaacn fill nut thn RRP
•FETY kRMIT/PLAN CH. ECK APPLICATION
Menifee
DATE / PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL )4 RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION- O ELECTRICAL XIVIECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Ff c- r nui , _ P. / /- -3- Lb� I ���-7�
PROJECT ADDRESS �tG,i c.��� cf 1� 1�7"z,-s '
ASSESSOR'S PARCEL NUMBER 3-�?5 L 23 l LJ.3 Z LOT 5C, TRACT
� Clty of Menl e
OWNERNAME Cli-�� '� _/L. & Safety Daft•
ADDRESS �.Cl�c/il-n-7 Q —r7 -( CA---L .�1--C� ,
PHONE (J � //(0 7 � I�C� EMAIL
APPLICANT NAME (_,.{ f
ADDRESS 305-- /)o K u rrr ete Mtn i F CA g25F5,4
PHONE (q5l) (r-;7q- 502 n EEMAII-n-Ion KSo l Y'Lt7 rYa:d • ary-,
CONTRACTOR'S NAME C Q-Ily ) yl D'^Lf ,.( OWNER BUILDER? OYES NO
BUSINESS NAME C MwV-,� Ir Condi ,bn
ADDRESS S ''f: I CA 1253 T
PHONE ( '�////��WLp�7q— `-/-, 0 - EMAIL monIC-SCti rZ rnCLL-L7• Czm
'mil 1/
CONTRACTOR'S STATE LIC NUMBER . 2 113L( n LICENSE CLASSIFICATION CLQ
VALUATION$l 2, SO FT I "I L SO FT
APPLICANT'S SIG NATURE r DATE
CFFYSTAFFUSEONLVP
DEPARTMENT DISTRIBUTION CITY aF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE ' PAIDAMOUNT
AMOUNT 0CASH 0CHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEFS PAID AMOUNT O CASH O CHECK a O CREDIT CARD VISAINIC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER O YES NO
City of Menifee Building&Safety Department 29714 Houn Rd. Nlanifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
➢ w n o. m V ton w T T D v D m
O A
LL tp Z w y� N n N n T a IF
➢ ➢ 3 ,^� .dr •n
o o m w NDi
On 3 N Om
❑ m n
O d N 00 Q O O
✓� not p^ m o vOi in ° ❑ _y a
p n
�- o-w• K 7 6 0 N N N S C � m
d —
a
rn 4 � N n O ❑ N m w+ � w a m
A O GI N < T O DJ 7 01 � C N3
Ol w N
N D o 3
o nt to 3 m w d o o 0
m' a � � x n 1D ❑ f° a. �
o a � •� o'
a o w o
3 a ❑ n w r
J n ff n m
1 N O <
n _
^ 3 j ' n
� twit N o d e = N f
� S
N A A O N j O j w
N m N V J 00 W d C>
3 m p v- 3 o m m c m w - in
O •J N ry O w w A
CL
g m 3 c H w
74
top o
m •J o � y o. m
v
Z m' w o •+ � o O0 'm
3 0 3
^ N _
N
Z C N N O O
m O
a 3fw �
J �
N _ �
2 �
N A ^ �-
O N a ➢ D C
V 2 O O w O T
O m J ID Y+ N N N A
O
P�'fl`7 or 4407
m : x o TNa No „ n a O D n
0 AD
Z z « N m o c m 3 O H C m
AD ED
m c N IZD n -" nna nm �n
m 3 � 3 3 m N N d i c o n n v T
A, H S AD
W n
3 N N (� A
n n £ �.A n a rt O O
j O O c i o �. O .c. n w = N N O n
p _'CD d o m � 3 rr Z
n
a fD ID o' ii J � O
a D ¢ W.q e a 3 o d a w m CD
m o AD
N rD w £ m w a W
£ `
AD
m � o
O1 O AlAD
H 'n n nO. o e°ry m C 'O AD O N
fl o
0 0
g o O n
?�
< a � ,� ° Ado " n
v o �n m " > > m c
0 3 N
r°y G v d, o Nn Nwn G 7j3 2
'
as G ? 3 n o
ADa o a C w G
c � " O < 3 A a n
< n a
0 3 o one a " p
C .`^-.
m m N N m F, v Q
o w n .a o m `0 a .. a_ < w
-
w � y O 3 O .a ym ao N
3 D 3 nD
w' 3 3 "' m £ ra w a
GN n cu
w 3 ° ,.
ro
c' vpi
N n
° < n. O O
ON ear F z a a O n OG
p O j
° > > m
� N O
a F.
m m o m 3
on
o
C �
of '
m A �
O. m m
m
0 o F m AD
m D- �
m ry m ti
m
z
A �
m n m m
ojai, c n
V c T
N y N Z d A
n S
mLn
D
R N
FV,u ti o' o O¢ N » W N
m
n v m
s 3n W a 30 N - A 3 ^- W a � 0 3o !''
w m Na 03 O 'p j N m N Nn 03 O < O D m
a
� O �n F m m c
n a o m 9 � to;` Glv s 7 m � � v+` .n ' a 3 D
j O - a 9: ?fi d( g
D .d+ Z >
O p
o N p w N O>D S N N m
A. � w o �' 'O N d O c » T O
c W F Z p '" o a 3 m w m W Z
A N n it 3 C S L C
R NO •3 O' 0 a N m
m m <
„p,w m ?a a H `.° N S o v
O C
J yNj S m m N 9 O J p � 1 d 0 O T
Om n_
d �
D m wm < aE
y 6 m T
d 9 V1 u3i
m n
O Oa v o y 3 'F^ m 3 3
CL m i
N O O <
3 c o 3 a.mom. a 3 M ry N c r
d 3
n - m
d sst
m o m w a o? o =
3 - ' n a ° 3 <
.. pa A N D
ir
ada
m N n n m £y d
�•y w 'a 4 i= 0 3
m m p c tO lD N p m
Ft
O O a 3 m f+ m v W 2 a ?W
'J• N m A O p N F w rt 'A N a v N O n N
y wA v n ee art 3 : w A n V e0i
r o co - 3 u F >' p (OO 1°
m
C N
mg < UT vi 3 m' nm a o
No w' m m o a 3 m N
aUi p m a ?
o a w n
Ei
N O - 'J- � A � '•
a O J M
m n 3
N m m m
j �0
^ w m a a m
m
M
Am o 3 0 o ff
n m a
v
o vAi 3 ' H a m
0
F• w ''� =p rt a= m
r,l a r
v •• O c p Oy, N