PMT18-01744 City of Menifee Permit No.: PMT18-01744
29714 HAUN RD. Type: Residential Mechanical
CCEL/+ MENIFEE, CA 92586
MENIFEE Date Issued: 04/19/2018
PERMIT
Site Address: 27147 SUN CITY BLVD, MENIFEE, CA Parcel Number: 337-262-022
92586 Construction Cost: $6,568.63
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, NEW CARRIER 2.0 TON 14 SEER SINGLE STAGE R410a SPLIT A/C 45,000
Work: BTU FURNACE
Owner Contractor
DON CLARK MONK'S AIR CONDITIONING
27147 SUN CITY BLVD P O BOX 128
MENIFEE,CA 92586 SUN CITY, CA 92586
Applicant Phone:9516794502
TIFFANI MONK License Number:912194
MONK'S AIR CONDITIONING
P0 BOX 128
SUN CITY,CA 92586
Fee Description O_yt Amount($)
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 licensure under the Contractors'State License Law fort
following reason:
I hereby affirm under penalty or perjury that I am licensed under provisions of
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 I must have resided for at least one year prior to completion
License Class a
llo. I Zt! improvements covered by this permit,I cannot legally sell a structure that I ha
Expires 3-3 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
submitted or at the following Web-site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: http://www.leginfo.ca.00v/calaw.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, I certify to each of the following: I am the prope
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 tl
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 coml
permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to buildi
construction.I authorize representatives of this city or county to enter the abox
Carrier ! identified property for the inspection purposes.
J _ — Date
Policy#12-�bD- I Expires
Property Owner or Authorized Agent
(This section need not be completed if the permit is for
City Business License
one-hundred dollars($100)or less) #
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 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 f hwith mply with those provisions.
OYES NO
Appli ant, 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 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 out
DAMAGES AS PROVIDED FOR iN SECTION 3706 OF THE bounds`,'EN of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑YES O
CONSTRUCTION LENDING AGENCY 1 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.1 understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health A Safety C e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mate Ire orti
OWNER BUILDER DECLARATIONS ❑YES NO1
Date
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the reason(s)indicated below by the checkmark(s)I have placed PRO OAk,04 AUTHORIZED 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(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 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•Businpss 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 703:1.5 by any Applicant forma 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 roe or m employees with wa es as their sole �.epa.gov/lead or contact the National Lead Information Center at
property,rtY Y9 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 does not apply to an owner of a property p An EPA Lead-Safe Certified Renovator will be responsible for this projec
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: • f
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 Certification 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:
contractors 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 oroiects with a
BUILDING & SAFETY PERMIT/.PERMIT/PLAN CHECK APPLICATION
Menifee
® n
DATE — PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O§16h ing Dept.
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL X.MECHANICAL 2018
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK hC Q erg ri_,e
PROIECTADDRESS Z-7 `�� �� Z5 0
ASSESSOR'S PARCEL NUMBER j 7j�',Z L LOT r TRACT
OWNER NAME Ll c—L
ADDRESS - V C
PHONE<O/2 ) / - l q 7 2— EMAIL
APPLICANT NAME r
ADDRESS 30530 M ii rr mla I ( ' tt CA q 5g 4
PHONE (q5l ) (e-- !q-g502_ EMAIL I nonKSo l r Q� mccd a cbrn
CONTRACTOR'S NAME 1.� �-Ir AA I DI L �V, OWNER BUILDER? O YES NO
BUSINESS NAME M OnV-1,5 (r Cur Id( 'b n ( Q
ADDRESS 5 r '� ( GA -I25 14
PHONE (Q5/� 6-7q, 4,50n2.. EMAIL monl-sa'lr Z ►y,06-L • Garr,
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION C20
VALUATION$ ( SQ FT - "�` L SQ FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE •GREEN SMIP
INVOICE PAID AMOUNT AMOUNT ' O O CASH CHECK# CO CREDIT 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 Deportment 29714 Houn Rd. Menifee, CA 92585 951-572-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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