PMT17-04039 City Of Menifee Permit No.: PMT17-04039
29714 HAUN RD. Type: Residential Mechanical
`�—ACCELA—>. MENIFEE,CA 92586
W.— MENIFEE Date Issued: 1111312017
PERMIT
Site Address: 27695 CAMINO VACUNA, MENIFEE,CA Parcel Number: 336-317-006
92585 Construction Cost: $5.582.63
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT,CARRIER 3.0 TON, 14 SEER, R410A SINGLE STAGE SPLIT A/C W/70K BTU
Work: FURNACE
Owner Contractor
MYRNA DUVALL MONKS AIR CONDITIONING
27695 CAMINO VACUNA 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 city Amount ISI
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_BIdg_Permit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'Stale License Law for if
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 t which 1 must have resided for at least one year prior to completion
License Class_ 1�Licens N )2_10LI improvements covered by this permit, I cannot legally sell a structure that I ha,
Expires 3-31-! R' Signatu built as an owner-building if it has not been constructed in its entirety by licenst
contractors. I understand that a copy of the applicable law, Section 7044 of if
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: htto:/Mww.leoinfo.ca gov/calaw.html.
I have and will maintain a certifice.e 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 or Authorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the proper
&L I have and will maintain workers compensation Insurance, as required by owner or authorized to act an the property owner's behalf. I have read tr
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 carrier and policy number are: with all applicable city and county ordinances and state laws relating to buildir
construction.I authorize representatives of this city or county to enter the abov
Cartier c- Q r identified property for the Inspection purposes.
Policy#12- /00— I2- Expires V — — l O Q� Date
Property Owner orAuthorized Agent
(This section need not be completed If the permit is for 0:55(o79
one-hundred dollars($100)or less) City Business License#
I 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 ecified on the Hazardous Materials Information Guide?
Code,I shall h ' mply with those provisions. �/ ❑YES XNO
Appli nt• Date; / (. :1! � _ 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 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 100D feet of the outf
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounds of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES NO
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 concerning
3097 Civil Code) hazardous mate 1 re orb
OWNER BUILDER DECLARATIONS DYES NO I
I hereby affirm under penalty of perjury that I am exempt from the Contractors /Date / 4/ 2
License Law for the reason(s)indicated below by the checkmark(s)I have placed PRA OVVNAa,04AUTHORIZED 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, EPA RENOVATION.REPAIR AND PAINTING(RRPI
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-Busingss 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 for. 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 EPA's Renovation Program visit:
❑ I, as owner of the property, or my employees with wages as their sole www.epa.govflead or contact the National Lead Information Center at
1-800-424-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 noes 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.:
❑ 1, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Firm Is required for this project because:
contractors to construct the project(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
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE ( — PERMIT/FLAN CHECK NUMBER
TYPE: O COMMERCIAL X RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL XMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK /I C Q ) - 5EEk
c I
PR( ECTADDRESS
ASSESSOR'S PARCEL NUMBER 3 (0 31�qr-o1O b LOT 3 of TRACT I S3 F�3
OW yNER NAME a-C
ADDRESS
PHONE ��fj ' Gj�_ EMAIL
APPLICANTINNA/MME r^ ^ + ' A /�p v� (`,, �+,� /��7
ADDRESS `JcV� /�-7O/] Ivl lJr, Iv ` LL ' lLt CA gl5N
PHONE rqJl ) � 502 /. �EEMAIL►nw1KSATr� ► 10-!J - corn
/ V I CONTRACTOR'S NAME lam{Lr- I QT L.K OWNER BUILDER? OYES iNO
BUSINESS NAME I r CcIndthomh4
ADDRESS //�� S ( cA `"/2S 4
PHONE ("/S�� gp157,- y',5Q2, +�]/ ,EMAIL monksairZ ►'rxC6-�. . CDrr1
/�/
CONTRACTOR'S STATE LIC NUMBER 'mil!2 I L LICENSE CLASSIFICATION C20
VALUATION$ 2 I SOFT 3 L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE
AMOUNT PAIDAMOUNT OCASH OCHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZED LETTER 0 YES O NO
City of Menifee Building&Safety Department 19714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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