PMT17-02690 City of Menifee Permit No.: PMT17-02690
29714 HAUN RD. Type: Residential Mechanical
�!-�CCEL/> MENIFEE,CA 92586
MENIFEE Date Issued: 08/02/2017
PERMIT
Site Address: 27311 WENTWORTH DR, MENIFEE,CA Parcel Number: 336-075-001
92586 Construction Cost: $6,795.94
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, CARRIER 3.0 TON, 14 SEER,80%AFUE, R410A SINGLE STAGE SPLIT A/C,
Work: 70K BTU FURNACE
Owner Contractor
MARK&DONNA BERGINE MONK'S AIR CONDITIONING
27311 WENTWORTH DR P 0 BOX 128
MENIFEE, CA 92586 SUN CITY, CA 92586
Applicant Phone: 9516794502
GARY MONK License Number:912194
MONKS AIR CONDITIONING
PO BOX128
SUN CITY,CA 92586
Fee Description City Amount 151
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_Penmit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from Iicensure under the Contractors'State License Law fort
I hereby affirm under penaltyor 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 of which I must have resided for at least one year prior to completion
License class _Ucens No. 2 improvements covered by this permit,I cannot legally sell a structure that I he
Exp(res3-3I Signatu built as an owner-building has not been constructed in its entirety by ftcens
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 application
submitted or at the following WebsBe: _
❑ I hereby affirm under penalty of perjury one t the following for workers!
hftplAv .leoinfo.m.cov/slaw 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
permit is issued. Property Owner or Authorized Agent
Policy# ❑_By my Signature below, I certify to each of the following: I am the prope
I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owners behalf. I have read tl
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 coral
permit is issued.My workers'compensation insurance carder and policy number are: with all applicable city and county ordinances and state-laws relating to buildi
C� . construction.I authorize representatives of this city or county to enter the abo%
Cartier c. / identified property for the inspection purposes.
Policy#'2 Expires property Owner orAufhorized Agent +�� Date
(This section need not be completed If the permit is for City Business License
O3 ✓Y/79
one-hundred dollars($100)or lass)
1 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 ecfied on the Hazardous Materials Information Guide?
Code,I shall f mplywtththose provisions. �'f DYES
Ve
Appli 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 pernittingcheckii
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
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the out
DAMAGES AS PROVIDED FOR 11N SECTION 3706 OF THE bounder<ofaschool?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES , kNO .
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health$i Safety Cyyyggqe,Section 25505 and 25534 concerning
3097 Civil Code) hazardous matej( I re orti --1 �7 OWNER BUILDER DECLARATIONS ❑YES NO(
Dale /��I�I l
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROk-RT<0ViNAR AUTHORIZED AGENT
next to the applicable fem(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 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-Bi,sings amd Professions Code)or that he or residence or childcare facility 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 703;1.5 by any Applicant for,a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a cwii penalty of not more than($504) employees.For more information about EPA's Renovation Program visit:
❑ 1, as owner of the property, or my employees with wages as their sole www.epa.gov4ead or contact the National Lead Information Center at
compensation,will do( j all of or( j porting of the work,and the structure is 1-800-024LEAD(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 ❑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 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 purpose of sale). Finn Certification No.:
❑ I, as owner of the property an exclusively contracting with licensed 13 No EPA Lead-Safe Certified Finn 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 tdan owner of a property
who builds or Improves thereon, and who contracts for the projects with a
BUILDING SAFETY PERM!T/PLAN 'CHECK APPLICATION
Menifee
DATE -H)l - 1-1 PERMIT/PLAN CHECK NUMBERji
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION 0 DEMOLITION O ELECTRICAL VKMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES.
DESCRIPTION OF WORK hC- Cba8QE b Ii -7-1,-, 14 5&T-
\ I n c
PROJECTADDRESS Pr' IVI�E-vll CFL. � �C
ASSESSOR'S PARCEL NUMBER 3'S b O—1-v D® LOT Z-J' TRACT
OWNERNAME f-V7.�GL1 �'�' �L��;Y�r%I . �� I ru-) - '}
ADDRESS :J I N/u/
PHONE /EMAIL
y� �J
APPLICANT NAME �u Y .. f E.t,
ADDRESS �3 j0 Mt q �
PHONE ` 51 EMAILYY1C)Y1KSA I r tV 0 C -WW • C rn
CONTRACTOR'S NAME M o OWNER BUILDER? OYES NO
BUSINESS NAME jVto J o r CDndi o c
ADDRESS
////�� S/ q25
PHONE ( "lSl� LOx/�,Zn /], /EMAIL mOn ic-Salr Z rnaa_u - C-Dm
CONTRACTOR'S STATE LIC NUMBER 'mil I - I—/`7 LICENSE CLASSIFICATION
VALUATION$ �S. SO FT l FAO L SO FT
APPLICANT'S SIGNATURE e DATE
DEPARTMENT DISTRIBUTION n CRY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE ^� rrs PAID AMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
AMOUNT
PLAN CHECK FEES PAIDAMouNr OCASH 0CHECK# OCREDITCARD MSA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Une 951-246-6213
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