PMT17-02789 City of Menifee Permit No.: PMT17-02789
29714 HAUN RD.
4CACCEL/7 MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 08/07/2017
PERMIT
Site Address: 29005 CROSBY DR, MENIFEE, CA 92586 Parcel Number: 338-041-001
Construction Cost: $6,532.99
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, CARRIER 3.0 TON, 14.0 SEER R410A SINGLE STAGE SPLIT A/C SYSTEM,70K
Work: BTU FURNACE
Owner Contractor
MATT NELSON MONK'S AIR CONDITIONING
27225 AVENIDA DEL DIABLO P O BOX 128
TEMECULA, CA 92590 SUN CITY, CA 92586
Applicant Phone:9516794502
GARY MONK License Number:912194
MONKS AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description OQt( 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
$324.10
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Men'rfee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg Permit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from licensure under the Contractors'State License Law for t
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that,except for my personal residence
Professions Code license is in full force and eff _ which I must have resided for at least one year prior to completion
License Class _Ucens No. Z improvements covered by this permit,I cannotlegally sell a structure that I he
Expires'3-31-%R' Signatu built as an owner-bul ding if it has not been constructed in its entirety,by licans
contractors. I understand that a copy of the applicable law,Section 7D44 of t
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: httr)ithv M1v.leainfo.m.aovlcalaw.Mml.
I have and will maintain a certificate of consent of self-Insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code,for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the props
'$_ 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 0
section 3700 of the Labor Code, for the performance of the work for which this application and the Information I have provided Is coned I agree to coml
permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to buildi
construction.I authorize representatives of this city or county to enter the abm
Cartier !� Q Q� identified property for the inspection purposes.
Policy#1�7 — C)0— I Z r Expires u — — l V Date
Property Owner or Authorized Agent 2
(This section need not be completer'If the permit is for oij 7g
one-hundred dollars($100)or less) City Business License#
540
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 ff I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'oompensaton provisions of Section 3700 of the Labor amounts s erdfled on the Hazardous Materials Information Guide?
Code,I shall f mply with those provisions. ❑YES)NO
Appli n Date; Will the intended.use of the building by the applicant or future building
occupant require a penult for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air quality Management District(SCAOMD)?See permitting checkfi
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 bullding or modified facility be within 1000 feet of the out
DAMAGES AS PROVIDED FOR 1IN SECTION 3706 OF THE bounds of a school?
LABOR CODE,INTEREST,AND ATTORNEYS FEES CI
LABOR
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAOMD
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 Cyyy e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mate ?7�
OWNER BUILDER DECLARATIONS ❑YES NO
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date
Ucense Law for the reason(s)indicated below by the checkmark(s)I have placed PRO O4NAaPK AUTHORIZED AGENT
next to the applicable Item(s)(Section 7031.5. Business and Professions Code:
Any city or county that requires a ponmit to construct, alter,improve,demolish, EPA 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-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 for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant fora 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, as owner of the roe or m employees with wa es as their sole www.epa.govllead or contact the National Lead Information Center at
property,rty, y9 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 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). Firm Certification No.:
❑ 1, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Firm Is required for this project bemuse:
contactors to construct the prgject(Section 7044,Business and Professions
Code:The Contractors License Law does not apply td an owner of a property
who builds or Improves thereon, and who contracts for the projects with a
,:-----_______------_..........—__ e._._ „_____, __•__,.....u.1n.oen_a_ an....,a...000
BUILDING &SAFETY PERMIT/PLAN CHECK APPLICATION
A.. Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: C COMMERCIAL }`E RESIDENTIAL O MULTI-FAMILY C MOBILE HOME 0 POOL/SPA O SIGN
SUBTYPE: � ADDITIQN O ALTERATION 0 DEMOLITION C ELECTRICAL XMECHANICAL
_0 NEW C PLUMBING O RE-ROOF-NUMBER OF SQUARES
rDESCRIPTION OF WORK �C� U.a:
PROJECTADDRESS L`"�CY'i� '(�`:��. L1�' • n,'it'11i-f C /- `r,�`. 1
ASSESSOR'S PARCEL NUM e10 TRACT Z 3 ✓e `'t
q
OWNERNAME IV' 11�,/�
I I+� (' �1
ADDRESS.).. c� -�/eA-k.ido Cf!
PHONE 1�I(` C� /'�� I/EMAIL "—
APPLICANT NAME & ry Q V,
ADDRESS /3�c0' 45'60/� M u r�r Mer I fete cA c? SR F
PHONE (q51) (t-;7q`Lf502y� `� EEMAILYI' onKj0irtD CY1Gt,d . cbyn
CONTRACTOR'S NAME U r 1 V I D//L K ,,J OWNER BUILDER? OYES NO
BUSINESS NAME c MonV_!� Any- andi 'on
ADDRESS /� "��J 't✓ ( ( e qZS T
PHONE (R51 1 6;1q— 4, )n2- EMAIL mOnl6-sdtr Z "_tC6_L . Gom
CONTRACTOR'S STATE LIC NUMBER P121qL/ LICENSE CLASSIFICATION CZ-0
VALUATION$ (L' ':); >„J_ , <<r SO FT I00� LSQFT
APPLICANT'S SIGNATURE DATE
0TYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP
INVOICE ya .I PAID AMOUNT
AMOUNT ;!JI d CASH CHECK k O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH C CHECK N 0 CREDIT CARD VISVMC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-6 72-677 7
www,cityofinenifee.us Inspection Request Line 951-246-6213
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