PMT18-03964 City of Menifee Permit No.: PMT18-03964
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 08/10/2018
PERMIT
Site Address: 27195 MONK ST, MENIFEE, CA 92586 Parcel Number: 335-314-005
Construction Cost: $7,738.31
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, NEW AMERICAN STANDARD 3.0 TON, 14 SEER OVER/UNDER HEAT PUMP
Work:
Owner Contractor
JAY WILGUS MONK'S AIR CONDITIONING
27195 MONK STREET P 0 BOX 128
MENIFEE, CA 92586 SUN CITY,CA 92586
Applicant Phone: 9516794502
TIFFANI SELLERS License Number:912194
MONKS AIR CONDITIONING
P0 BOX 128
SUN CITY, CA 92586
Fee Description O,_yt Amount t51
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_Permft_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from licensure under the Contactors'State License Law for t
1 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 of }} which I must have resided for at least one year prior to completion
License Class Cn� Ucens No. 12� improvements covered by this permit,I cannot legally sell a structure that I ha
Explres�20 Signatu built as an owner-building if it has not been constructed in Its entirety by licens
contactors.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:
❑ I hereby affirm under penalty of perjury one the following declarations: htto:IAvww.leginfo.m.gov/mlaw.htm].
I have and will maintain a certificate 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 prope
.vi 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 if
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 buiddi
construction.I authorize representatives of this city or county to enter the abox
Carrier t�7I Identified property for the Inspection purposes.
Policy#I L— 1�t�� /Z Expires 0'— ' — /J_ Date
Property Owner or Authorized Agent 22�j/�
(This section need not be completed If the permit is for City Business License# OV ' 40-79
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 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 ecifred on the Hazardous Materials Information Guide?
Code,I shall f hWt mply with those provisions. ❑YES 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 OYES J<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 ofaschooI?
LABOR CODE,INTEREST,AND ATTORNEYS FEES OYES ,ZNO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affimr 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 Cyy e,Section 25505 and 25534 conreming
3097 Civil Code) hazardous mate I re orh g.
OWNER BUILDER DECLARATIONS ❑YES NO Date
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the reasons)Indicelad below by the checkmark(s)I have placed PRO O N AUTHORIZED AGENT
next to the applicable Items)(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(RRPJ
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 contactors
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)of that he or residence or childcare facility to be RRP-certified firths and comply with
she is exempt from licensure and the basis fir the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 703:1.5 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 mom than($500).) employees.For more information about EPNs Renovation Program visit'
❑ I, as owner of the roe or m employees with we es as their sole www.epa.govllead or contact the National Lead Information Center at
compensation,will do property,rtY y g 1-800-424-LEAD(5323).
p ( )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 ❑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 Finn 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 contacting with licensed 0 No EPA Lead-Safe Certified Firm Is required for this project because:
contactors to construct the prgject'(3ectfon 7044,Business and Professions
Code:The Contractor's License Law does not apply td an owner of a property
who bugds or Improves thereon, and who contacts for the projects with a
__----------......._.,._ ..__�__._-_..._._ ,:_____,_.... u..........
• s • • APPLICATION
FMenifee
DATE ��/ PERMIT/PLAN CHECK NUMBER LJ J ley
TYPE: O COMMERCIAL -)t RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION C ALTERATION O DEMOLITION O ELECTRICAL XMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
f
DESCRIPTION OF WORK T�A.C. 0 � S 'ly O nif e
o d e r i,Ln " I ,(C-A- l
PROJECTADDRESS 2 `n: L- _ Q �25R-
ASSESSOR'S PARCEL NUMBER 1 ��J 3� -c�\0��� LOT - � �j� TRACT �NeeeiVEd
OWNER NAME
7 V�J�. VV I Lt J
ADDRESSG Lv ICLI C -.�j' (-i r' N e - E XT. Y� ME 0 SqbL.
PHONE &)1 57 3 -77 CJ8/�y� /EMAIL
APPLICANTNAME (..� �rU . LJI Q/,
3�53o ri e Iz, tad, M�eri i ref cry C 5W
ADDRESS /�c, / /� �1 M
PHONE (951) �P�t?-1 5U✓Gy-� /� EMAILn-g> 1KSO11'-eD Gj1'Y1o{d - am
CONTRACTOR'S NAME l�1 A-r 1 V I Dry,/`,, ,.( OWNER BUILDER? C YES NO
BUSINESS NAME
�C a^ 1 I r Cbndl -on I
ADDRESS nn'c-L 5_ 7Onn M l)r ri m, Rd � M-wl I CA �25
PHONE (q / (p�✓j— 4,902- /] EMAIL rnonksa-tr � vy,, k-L GDYYN
CONTRACTOR'S
STATE LIC NUMBER `�//2 I'/Lf LICENSE CLASSIFICATION �LQ
VALUATION$ ( �� J� SQ FT L SO FT
APPLICANT'S SIGNATURE / DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINES',UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN �� SMIP
INVOICE
AMOUNT PAID AMOUNT CJ O CASH O CHECK# O CREU f 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 O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-6%2-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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