PMT17-03480 City of Menifee Permit No.: PMT17-03480
29714 HAUN RD.
471CMILA> MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued:
10/02I2017
PERMIT
Site Address: 28255 VIA CASCADITA, MENIFEE, CA Parcel Number: 336-315-010
92585 Construction Cost: $6,053.06
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT CARRIER 2.5 TON, 16 SEER, R410A SINGLE STAGE, SPLIT A/C SYTEM,70K
Work: BTU FURNACE
Owner Contractor
CYNTHIA VANNOY MONKS AIR CONDITIONING
28255 VIA CASCADITA P 0 BOX 128
MENIFEE, CA 92585 SUN CITY, CA 92586
Applicant Phone: 9516794502
GARY MONK License Number: 912194
MONKS AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description gyt Amount t$)
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_Permit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from 0censure under the Contractors State License Law fore
I hereby affirm under penalty or perjury that 1 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 2ndAylicanse is in full force and eff f which I must have resided for at least one year prior to completion
License Cl ess_ _Licens No. 2-1 improvements covered by this pern8,I cannot legally sell a structure that I hat
Expires Signatu built as an owner-building If it has not been constructed in its entirety by licens(
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 penally of perjury one t-the folloelf-Insu for wotions: http:/A n.leginfo.m.gov/mlew htrnl.
1 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 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 buildh
construction.I authorize representatives of this city or county to enter the abov
Carrier I Q p' Identified property for the inspection purposes.
Policy#12-7 /b0- /2- Expires U — / — �O Date
Property Owner orAuthorized Agent 2
(This section need not be completed if the permit is for City Business License# O351y7(�a
one-hundred dollars($100)or less) h'
`4 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 f rture-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 ecified on the Hazardous Materials Information Guide?
Code,I shall mply with those provisions. �J ❑YESNO
n Appli t• Date; �: I �I 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 COVERAGE IS UNLAWFUL, AND SHALL for guidellnes '
SUBJECT AN EMPLOYER TO CRLMINAL 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 feel of the out(
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounds of school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES
N0
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 Califo4mate
Safety Cyyy e,Section 25505 and 25534 concerning
3097 Civil Code) hazardIre orb
OWNER BUILDER DECLARATIONS ❑YESq-2-7
I hereby affirm under penalty of peij,Iry that I am exempt from the Contractor's Date .
License Law for the resson(s)IndlcateJ below by the checkmark(s)I have placed PRAR0V&k,014 AUTHORIZED AGENT
next to the applicable items)(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(RRP1
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 ficensed 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•Businkess and Professions Code)or that he or residence or childcare facility to be RRP-certified limns and comply with
she Is exempt from Xcensure,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 EPRs Renovation Program visit:
❑ I, as owner of the property, or my employees with wages as their sole www.epa.gov/lead or contact the National Lead Information Center at
compensation,will do( )all of or( )porting of the work,and the structure is 1-800-424LEAD(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 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 Certlficafion 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 Contractors License Law does not apply t6 an owner of a property
who builds or Improves thereon, and who contracts for the projects with a
sFETY PERMIT/PLAN CHECK APPLICATION
Menifee '
DATE PERMIT/PLAN CHECK NUMBER '� w
TYPE: O COMMERCIAL )4 RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA C SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION C ELECTRICAL X.MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK P(C11 dwLx bui
Ili k 1�I v f L'.�vu
PROJECT ADDRESS 2-C>% 1 C1 ��a CCl �� t'/�I C� Z�y�>
ASSESSOR'S PARCEL NUMBER I �0 3 `�D LOT TRACT I S 3 6 3
OWNER NAME
ADDRESS
PHONE �l` /b /L'( I _ EMAIL
APPLICANT NAME
ADDRESS /3� 05/3-on M U�1�)r M en i e CA C125R4
PHONE (%�) Ir-;7L? g502- EMAILn-jonK5oiYtD ►Y' 1CIrA . Coy,
CONTRACTOR'S NAME aax AA I OI I-K ,,J OWNER BUILDER? OYES NO
BUSINESS NAME J it Cbndi bn
ADDRESS 5 I'ic ( Z
C� q5 F T
PHONE (q5l� (p77q— 4,9 - /]� (EMAIL monl-SalraD rr-Lo6.L�7• GDm
CONTRACTOR'S STATE LIC NUMBER `mil I Z�-J`y LICENSE CLASSIFICATION CLQ
VALUATION$ le2, - - SO FT L SO FT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY-
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP
INVOICE 'Q PAIDAMOUNT
AMOUNT OCASH OCHECK# CCREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-572-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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