PMT17-02788 City of Menifee Permit No.. PMT17-02788
29714 HAUN RD.
�A_CCEL/%> MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 08/07/2017
PERMIT
Site Address: 26934 CORTE ADELITA, MENIFEE,CA Parcel Number: 330-292-014
92585 Construction Cost: $5,943.63
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, CARRIER 3.0 TON, 14.0 SEER, R410A SINGLE STAGE SPLIT A/C SYSTEM,
Work: 70K BTU FURNACE
Owner Contractor
PAUL&SUE FITZPATRICK MONKS AIR CONDITIONING
3538 GIRD RD P O BOX 128
FALLBROOK, CA 92028 SUN CITY, CA 92586
Applicant Phone: 9516794502
GARY MONK License Number:912194
MONKS AIR CONDITIONING
P 0 BOX 128
SUN CITY, CA 92586
Fee Description Qtv Amount lEl
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 erors 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 staled,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_Pernit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure 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 eft which I must have resided for at least one year prior to completion
License Claw t�_Licens No. Z improvements covered by this permit,I cannot legally sell a structure that I he
Expires 3-3 i Signatu built as an owner-building ff it has not been constructed in Its entirety by llcens
contractors. I understand that a copy of the applicable law,Section 7044 of t
WORKERS'COMPENSATION DECLARATION Business and Professions Cade,is available upon request when this application
submitted or at the following Web site:
❑ 1 hereby affirm under penalty Dt perjury one of the following declarations: httol/vnvw.leainfo.ca.cov/calaw.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 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!
— _ construction.I authorize representatives of this city or county to enter the atim
Carrier Q p' identified properly,for the Inspection purposes.
Policy#12-7b0- I2 Expires V — — O Date
Property Owner or Authorized Agent 22�/�
(This section need=be completed If the permit is for City Business License# O J ✓YW-72
one-hundred dollars($100)or less)
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 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 edited on the Hazardous Materials Information Guide?
Code,I shall mply with those provisions. DYES amounts
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 permitting checkli
COMPENSATION COVERA.3E 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 IN SECTION 3706 OF THE bounds oIfa 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.1 understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section Califomia Health ASafetyCyy e,Section 25505 and 25534 conoeming
3097 Civil Code) hazardouqNO
I re ort g.
OWNER BUILDER DECLARATIONS ❑YES
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 PRO OVJNAtP4 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, ERA RENOVATION,REPAIR AND PAINTING fRRPI
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-Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firths and comply with
she is exempt from Jicensure.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 civil penalty of not more than($500).) employees.For more information about EPNs Renovation Program visit
❑ I roe or m employees with wa es as their sole www.epa.govAead or contact the National Lead Information Center at
, as owner of the
property,rty: Y9 1-800424-LEAD(6323).
compensation,well do( )all of or( )poring 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 projec
who, through employees' or personal effort,; builds or improves the property,
provided that the improvements are r;ot intended or offered for sale.ti,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 itwas not built or Improved for the Firm Certification No.:
purpose of sale).
❑ 1, as owner of the property an exclusively contracting with licensed El No EPA Lead-Safe Certified Firm Is required for this project because:
contactors to construct the project(Section 7044,Business and Professions
Code:The Contractors License Law does not apply lid an owner of a property
who builds or Improves thereon, and who contracts for the projects with a
,:_____I______________.._..__.._— n._._,,_____,_.... ,..._.._---:-_,I_____.____,....:u,cn. a _.i__,____au
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
+ Menifee
g
DATE - Ij PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL JIQ RESIDENTIAL -- MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL VMECHANICAL
o NEW O PLUMBING o RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK &C n L I J C> fan ., ��•�•`'�r
PROJECTADDRESS > - -r-i Ili _ ��/
ASSESSOR'S PARCEL NUMBER 330Zd120 \� LOT LA TRACT 7i '-kk
I
OWNERNAME
ADDRESS {C 7,5
PHONE Cq�'.��L"CJ! ' la• SGI C5Jz EMAIL
APPLICANT NAME & r
ADDRESS //3�� 5//30 M� U rr M� l f- CA � R'-
PHONE (`7�\J IP/q'`f502• EMAILn->onKSa l r tD g ma-:A . corn
CONTRACTOR'S CONTRACTOWS NAME a�l.I" ►v I� L r OWNER BUILDER? O YES NO
BUSINESSNAME cMorIV/ r Cbndi ,on I
ADDRESS
PHONE (C151� 6-76J- 4 /02 /EMAIL mon KSA'I r a7 rnCL; L • Gam
CONTRACTOR'S STATE LIC NUMBER "I/2 l`1 LICENSE CLASSIFICATION
VALUATION 5 -5.4rl SO.FT 0 2 L SQ FT
APPLICANTS SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION I _ CITY OF MENIFEE BUSINESS UCEN5E NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE ; LlPAIDAMOUNT
AMOUNT • O CASH O CHECK If 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0 CHECK A 0CREDIT CARD VIWMC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER 0 YES O 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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