PMT17-04326 City of Menifee Pernit No.: PMT17-04326
29714 HAUN RD.
-5 -�CCELA> MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued:
12/07/2017
PERMIT
Site Address: 26653 JAELENE ST, MENIFEE, CA 92586 Parcel Number: 335-283-010
Construction Cost: $9,302.56
Existing Use: Proposed Use:
Description of HVAC CHANGEOUT-3.5 TON, 14 SEER
Work:
Owner Contractor
JACK MILES MONKS AIR CONDITIONING
26653 JAELENE ST P O BOX 128
MENIFEE,CA 92586 SUN CITY,CA 92586
Applicant Phone:9516794502
MONK'S AIR CONDITIONING License Number:912194
P O BOX 128
SUN CITY, CA 92586
Phone:9516794502
Fee Description Qy Amount IS1
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 buillding 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_Permn Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ I am exempt from licensure under the Contractors'State License Law for it
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 effpo, which I must have resided for at least one year prior to completion
License Class � —Licens No. improvements covered by this permit,I cannot legally sell a structure that I har
Expires 3-31-!R' Signalu built as an owner-building If it has not been constructed In Its entirely 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 fallowing Web site:
❑ I hereby affirm under penalty of perjury one the following declarations: httol/vnvw.lecinfo.eamov/slaw html.
I have and will maintain a certificate of consentt of selFinsure 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:1 am the proper
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 cored 1 agree to comp
permit is Issued.My workers'compensation insurance carter 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
Cartier 5c� F Identified property for the inspection purposes.
Poffcy#I2-7n0— /2 Expires �S'- j — C Date
Property Owner or Authorized Agent 2 (�
(This section need rot be completed If the permit is for C Business License# O351v7$
one-hundred dollars($100)or less) m'
41 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 3 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 ecIll don the Hazardous Materials Information Guide?
Code,I shall f h mply with those provisions. . ❑YES vpe
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 checkiis
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 1000 feet of the outs
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounds 0 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 Cpp��e,Section 25505 and 25534 concerning
3097 Clwl Code) hazardous mate I re art
i
OWNER BUILDER DECLARATIONS ❑YES NO
I hereby affirm under pengity of perjury that I am exempt from the Contractor's Date
License Law for the reason(s)Indicated below by the chedcmark(s)I have placed PRO 0 NAaP4 AUTHORIZED AGENT
next to the applicable Item(s)(Section 70315.Business and Professions Code:
Any city or county that requires a permit to construcL alter,improve,demolish, EPA RENOVATION,REPAIR AND PAINTING(RRP)
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 Contractors 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 firms and comply with
she is exempt from Jlcensure.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,a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more then($500).1 employees.For more information about EPA's Renovation Program visit:
❑ 1, as owner of the roe www.epa.govAead or contact the National Lead Information Center at
of property, or my employees with wages s their sole
compensation,will do( )all of or( ,porting of the work,and thee structure Is 1-800.424-LEAD(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 persona: 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-
Bullder will have the burden of proving that It was not built or improved for the Firm Certification No.:
purpose of sale). ,
❑ 1, as owner of the property an exclusively contracting with licensed O No EPA Lead-Safe Certified Firm is required for this project because:
contactors to construct the project(Section 7044, Business and Professions
Code:The Contractor's License Law does not apply td an owner of a property .
who builds or Improves thereon, and who contracts for the projects with a
r� L
jkw -fee
DATE I , '"�I - I PERMIT/PLAN CHECK NUMBER-PIvII 1-1 -0 aV
TYPE: O COMMERCIAL X RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION 0 DEMOLITION O ELECTRICAL XMECHANICAL
O NI'E'W O PLUUM�BIIN`G _�0 RE-ROOF-NUMBER OF SQUARES _
DESCRIPTION OF WORK -N hC. C Y, ncr bu�f ft Cj+d 5 , f) HT.0
PROJECT ADDRESS 2-6 C,J O ,l . S"I -6 A 2 96,
ASSESSOR'S PARCEL NUMBER 3-3'9 7,�- 1 DI-0 LOT - } 00 ki4ng Dept.
OWNER NAME �( o �k- M I Lp_S
ADDRESS �LlL�//'} /.jP (� .'I G' IQAJjEJ L
PHONE( '( J (Q/���( I (��I(] EMAIL ���•
APPLICANT NAME �{ }-
ADDRESS /3�0/ 5-30/� M Ui� Mt i Ott CA g25R4
PHONE ('?JI ) (r-;7q'Lt SVL�Y� ,^ 'EEMAILYhonKSQIY'� ►Y}ZL) , corn
CONTRACTOR'S NAME l�l �-I� M�//1�^ ,..( OWNER BUILDER? C YES NO
BUSINESS NAME G I i t COnd 'o n i 'I
ADDRESS //�� 5 j� ( CI25 `f
PHONE (I 51� (p�q, �y//]]2- I/]� /EMAIL mon Ksc)r Z rnC6-L�/. GDm
CONTRACTOR'S STATE LIC NUMBER
�7'-/I2{-/Ly LICENSE CLASSIFICATION cLQ
VALUATION$ O , ,3 �_ SOFT 13 b L SO FT
APPLICANT'S SIGNATURE DATE
CfrYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE /J.., PAIDAMOUNT
AMOUNT ;/� � I OCASH C CHECK# OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0 CHECK# OCREDITCARD VIWMC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZEDLE17ER 0 YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd, Menifee, CA 92585 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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