PMT18-01604 City of Menifee Permit No.: PMT18-01604
29714 HAUN RD.
SkCCECA? MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 04/09/2018
PERMIT
Site Address: 25651 MCCALL BLVD, MENIFEE, CA Parcel Number: 339-041-002
92586 Construction Cost: $7,907.91
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, AMERICAN STANDARD 3.0 TON, 14.0 SEER, OVER/UNDER PACKAGE H.P.
Work: W/5 kW HEAT STRIP
Owner Contractor
LARRY STAFFOR MONK'S AIR CONDITIONING
25651 MCCALL BLVD P O BOX 128
MENIFEE, CA 92586 SUN CITY,CA 92586
Applicant Phone: 9516794502
GARY MONK License Number: 912194
MONK'S AIR CONDITIONING
PO BOX128
SUN CITY, CA 92586
Fee Description gyt Amount($1
Forced-Air or Gravity-Type Furnace or Bumer 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.
PA_BId9_Permit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from Iicensure under the Contractors'State License Law fort
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_ Licens No. 21 improvements covered by this permit,I cannot legally sell a structure that I he
Expires,3-3)"I R' 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 t
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application
will
submitted or at the fallowing Web site:
❑ I hereby under penally of perjury one of the following declarations: hhol/vn .leginfo.m.ciov/mlaw.htmi.
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,1 certify to each of the following: I am the prope.
I have and will maintain workers' co owner or authorized to act on the property owner's behalf. I have read 0
compensation insurance, as required is
section 3700 of the Labor Code, for the performance of the work for which this application and the Information 1 have provided Is correct I agree to ceml
perk Is issued.My workers'compensation insurance carrier and poky number are: with all applicable city and county ordinances and state laws relating to buildi
C construction.I authorize representatives of this city or county to enter the abm
Cartier Q identified property for the inspection purposes.
Policy#12-76D- ,Z Expires U — / — O Date
Property Owner or Authorized Agent 2
(This section need trot be completed If the permit is for
one-hundred dollars($100)or less) C' Business License#_ 035107 6 6
I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ any persons in on;manner so as to become subject to the Mi 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 ecified on the Hazardous Materials Information Guide?
Code,I shall mply with those provisions. Q' DYES amount
Appll 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 Distridt(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 1000 feet of the oub
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bound ofa school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑YESNO
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 Civil Code) hazardous matte I repord g.
OWNER BUILDER DECLARATION ❑YES NO
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Data
License Law for the reason(s)indicated below by the checkmark(s)I have placed PRO O N AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.6.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 thvl 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(commending with receiving compensation for most work that disturbs paint in a pre-1978
Section 7(100)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.Iicensure,and the basis for the alleged exemption.Any required practices.This includes rental properly owners and property
violation of Section 703:1.5 by any Applicant fora permit subjects the applicant to managers who do the palnl-disturbing work themselves or through their
a civil penalty of not more than($5004 employees.For more Information about EPA's Renovation Program visit
❑ I, as owner of the property, or my employees with wages as the sole wvvw.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 1-800-424-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 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). Finn Certification No.:
❑ I, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Firm is required for this project because:
oom;actors to construct the project(Section 70",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 • 11 • .
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL XMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUU�MBER OF SQUARES
DESCRIPTION OF WORK AC,
A �((-'.,�,
PROJECTADDRESS ?5� K5 � M� CcL-�� ��\Icy, pf 1i'e- 1 Clq 1177C�qq4JU
ASSESSOR'S PARCEL NUMBER LOT \3 TRACT
OWNER NAME �% -o -
ADDRESS _':") ,! G . GLbO VY,
n/
PHONE '�/�- /' -, /'Z - -�(D55 EMAIL ----
APPUCANTNAME _a r
ADDRESS //3�� 0\5/3a/� M v W M er j � CA G25W
PHONE (%� J �P� -—L1 502 EMAILrrionKSalrID 1'Y1Q.l-4 CAYYI
CONTRACTOR'S NAME U CV /'`
M Q OWNER BUILDER? OYES NO
BUSINESS NAME CMi)nVlS A-Ir C.�(Jndi-f om Q�7
ADDRESS S ( GA f 5 T�(
PHONE (q5l� (p__�q- 4,5n2 EMAIL monIcSatr C-4) rrxa._L - Gorr,
CONTRACTOR'S STATE LIC NUMBER �I I Z I'!LI A/ LICENSE CLASSIFICATION CZQ
VALUATION$ , G J
O (, "I � SQFT LSQFT ,
APPLICANT'SSIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CRY OF MENIFEE BUSINESS UCENSE NUMBER
Bu1LDING PLANNING ENGINEERING FIRE GREEN I SMIP X
INVOICE PAIDAMOUNT
AMOUNT •�� 3a • 1V O CASX OCXECK It OCREDIT CARD VISA/MC
PLAN CHECK FEEF PAID AMOUNT O CASH O CHECK It O CREDIT CARD MSA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZEDLETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.citycfinenifee.us Inspection Request Line 951-246-6213
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