PMT17-03756 City of Menifee Permit No.: PMT17-03756
29714 HAUN RD.
<NCCEL/_> MENIFEE, CA 92586 Type: Residential Mechanical
" MENIFEE Date Issued: 10/19/2017
PERMIT
Site Address: 29363 CARMEL RD, MENIFEE, CA 92586 Parcel Number: 338-072-029
Construction Cost: $6,462.88
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, CARRIER 2.5, 14 SEER R410a SINGLE STAGE SPLIT A/C SYSTEM,70,000
Work: BTU FURNACE
Owner Contractor
DAVE FORMANEK MONKS AIR CONDITIONING
29363 CARMEL ROAD P 0 BOX 128
MENIFEE,CA 92586 SUN CITY, CA 92586
Applicant Phone:9516794502
TIFFANI SELLERS License Number. 912194
MONKS AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description gyt 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 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 Iicensure under the Contractors'State License Law ford
i hereby affirm under penalty or perjury that 1 am licensed under provisions of fallowing 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 licensen Is in full force and eft which I must have resided for at least one year prior to completion
License Class r, Licens No. 2 improvements covered by this permit,I cannot legally sell a structure that I he,
Expires3-31-! R' Stgnatu built as an owner-building If it has not been constructed in Its entirety by licensr
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:
❑ I hereby affirm under penalty of perjury one the following declarations: htto9Avww.leainfo.ca.aovlcalaw.html.
I have and will maintain a certificate of consentt 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 orAuthodzed 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 properly owners behalf. I have read D.
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
r^ construction.I authorize representatives of this city or county to enter the abov
Cartier � r Q `Q� identified property for the Inspection purposes.
Policy#12— /b0— /Z Expires Date
Property Owner orAuthorized Agent
(This section need not be completed It the permit is for 035lv79
one-hundred dollars($100)or less) City Business License#
I certify that ih 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 California,and agree that ff 1 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{p,ecified on the Hazardous Materials Information Guide?
Code,I shall f mply with those provisions. DYES�P2'�0
Appli nY 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 checklie
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 out(
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounds of school?
LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES KNa i
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¢ Safety C e,Section 25505 and 25534 conceming
3097 Civil Code) hazardous mateJ�I re ort
V
OWNER BUILDER DECLARATIONS DYES NO// 1y\ //lam/-7
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date ' U /
Uonse Law for the reasons)indicated below by the checkmark(s)I have placed PROk401'0dN&94 AUTHORIZED AGENT
next to the applicable items)(Section 7031.5.Business and Professions Code:
Any city or county that requires a permit to construct,after,improve, demolish, EPA RENOVATION,REPAIR AND PAINTING 1RRP1
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 fins and comply with
she Is exempt from.Iicensure.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($50D).) employees.For more information about EPA's Renovation Program visit:
❑ roe www.epa.govAead or contact the National Lead Information Center at
I, as owner of the p p rty, or my employees with wages as their sole 1-800-424-LEAD(5323).
compensation,will do( )all of or( )porting of the work,and the their
Is
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's Stale License Law does not apply to an owner of a property ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort; builds or improves the property,
provided that the Improvements are not Intended or offered for sale.If,however, Certified Firm Name:
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the purpose of sale). Firm Certification No.:
❑ I, as owner of the property an exclusively contracting with licensed 0 No EPA Lead-Safe Certified Firm Is required for this project because:
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's License Law does not apply lid an owner of a property
who builds or Improves thereon, and who contracts for the projects with a '
......_._e_.
Menifee
DATE I(� ( PERMIT/PLAN CHECK NUMBERWvT -
TYPE: O COMMERCIAL �4 RESIDENTIAL O MULTI-FAMILY MOBILE HOME O POOL/SPA C SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION C ELECTRICAL 'MECHANICAL
O NEW r1 A.�. L O PLUMBING O RE-ROOF-NUMBER OF SQUARES �t c..,
DESCRIPTION OF WORK Q l �L�'T - {� •5 - 0 `
PROJECTADDRESS ^ L I- CY4 L�
ASSESSOR'S PARCEL NUMBER -5 S'/O�''1_O Z LOT TRACT �X Ovk
OWNER NAME ^ \ .- ')i% U�
ADDRESS CI Of
/'' u ding & Safety Dept.
PHONE I J t'S ` G� ( EMAIL
r
APPLICANT NAME
ADDRESS nn3ccf�5//3��7o��jj M uMMr Men -�, C�1, q - 5R
PHONE (q5 ) (P !%-q502 EEMAILrylonK$Q I Y'I� rna: a • Cbm
CONTRACTOR'S NAME a0k-r MD(LK
,JJ OWNER BUILDER? O YES NO
BUSINESS NAME G Mnnl�/� C(r wdi on i
ADDRESS Sr r ( L�rT / L✓ 7
PHONE (�1n SI) 6�76�- 4 Xy 2- //�,Y(EMAIL mon kSc.i r c-D m.�.L • GD m
/�J
CONTRACTOR'S STATE LIC NUMBER "I I2 !-1` LICENSE CLASSIFICATION C2-0
VALUATION$ ?`? SO FT 12 ea� L SO FT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY.'
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAIDAMOUNT
AMOUNT C CASH O CHECK# O CREDIT CARD NSA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK 9 O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES C 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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