PMT18-03642 City of Menifee Permit No.: PMT18-03642
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 07/25/2018
PERMIT
Site Address: 28256 E WORCESTER RD, MENIFEE, CA Parcel Number: 337-090-034
92586 Construction Cost: $3,552.31
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, CARRIER 3.5 TON, 14 SEER R410a SINGLE STAGE&TXV, NO FURNACE
Work:
Owner Contractor
GARY ARNOLD MONKS AIR CONDITIONING
28256 E WORCESTER ROAD P 0 BOX 128
MENIFEE, CA 92586 SUN CITY,CA 92586
Applicant Phone:9516794502
TIFFANI SELLERS License Number:912194
MONKS AIR CONDITIONING
PO BOX128
SUN CITY, CA 92586
Fee Description 01t y Amount fSl
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 6.65
$167.65
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 building operations being carded 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_Pernit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from ficensure under the Conbaclors'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 1 acknowledge thal,except for my personal residence
Professions Code license is in full force and If which I must have resided for at least one year prior to completion
License Class __I, No. Z improvements covered by this permit, I cannot legally sell a structure that I he
Expires 3-31;ZQ Signetu built as an owner-building if it has not been consiructed In its entirety by Ilcens
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:/tvnwv.leginfo.ca.nov/mlaw.html.
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
1 have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read it
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 abo%
Carder r Q Q` identified property for the inspection purposes.
Policy#I Z— 700— / L Expires U — I — u Date
Property Owner orAuthodzed Agent �j
(This section need not be completed If the permit is for City Business License# 03 ✓!v7(�S
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 amid any persons in any manner so as to became 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 amountns�s{p,ec111 d on the Hazardous Materials Information Guide?
Code,I shall f hvd mply with those provisions. 17 YES,.' Z
Appil 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 checkli
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES XNO
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 ofa school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES ZNO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAOMD
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 mate) 1 re oN
OWNER BUILDER DECLARATIONS DYE S NOf
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date
License Law for the reasons)indicated below by the checkmark(s)I have placed PRO O4!NkP4 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 IRRP)
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 facilfty to be RRP-certified firths and comply with
she Is exempt from Jlcensure and the basis fdr the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 70S.1.5 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 theproperty, or m ern to employees with wages as their sole www.epa.govllead or contact the National Lead Information Center at
Y P Y 9 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 7D44,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 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:
the butl ding 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 0 No EPA Lead-Safe Certified Frn is required for this project because:
contractors to construct the prgjectJSectfon 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
__________... .d........an..,a.h.DOD
BUILDING & SAFETY'�ERIVIIT/PLAN CHECK APPLICATION
�PMenifee
DATE -7-2— - PERMIT/PLAN CHECK NUMBER - ;may Z
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL XNIECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK PrC 1 Yl ��Y -
QLALIQ S. L, d ._xV vZC� re
PROJECI'ADDRESS 2-
ASSESSOR'S PARCEL NUMBER 33';-001 fl o 3-A, 1 LOT TRA&Y O
Bul Ing Dept.
OWNER NAME
ADDRESS J JUL 2 3 2018
PHONECI�I ` I EMAIL
�/
Received
APPLICANT NAME r p p
ADDRESS /`�1cV'30550
Mj 1�J•y�- I" l� ' l I of CA CI O
PHONE rg5l ) �P (/1q--1502 � � �/EMAILrnDnK$0Jr9D YYToI J - am
CONTRACTOR'S NAME C C.I2 1 V I QI//x OWNER BUILDER? OYES NO
BUSINESS NAME c I j r [. and i o r) 1
ADDRESS /� S I CA q25
PHONE (IRQ� 0-7q— 7 02- /] EMAIL monksa)r Z rya--L • Gym
CONTRACTOR'S STATE LIC NUMBER j"1121-/Ll LICENSE CLASSIFICATION CZQ
VALUATION$.�S52. 3 I SQ FT Iv Z' L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION CRYOF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE 'GREEN ,J SMIP
AMOU�NR lQ PAID AMOUNT 6
O CASH OCHECK# OCREDIT CARD VISq/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VlWMC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O 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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