PMT18-04266 City of Menifee Permit No.: PMT18-04266
29714 HAUN RD. Type: Residential Mechanical
IfAr MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued: 08/29/2018
PERMIT
Site Address: 27515 PINCKNEY WAY, MENIFEE, CA Parcel Number: 336-351-005
92586 Construction Cost: $6,519.13
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, INSTALL NEW CARRIER 3.0,R410A SINGLE STAGE SPLIT A/C W170K BTU
Work: FURNACE
Owner Contractor
ARLEEN PAVAN MONK'S AIR CONDITIONING
27515 PINCKNEY WAY P O BOX 128
MENIFEE,CA 92586 SUN CITY,CA 92586
Applicant Phone:9516794502
GARY MONK License Number:912194
MONK'S AIR CONDITIONING
P O BOX 128
SUN CITY, CA 92586
Fee Description Div Amount 151
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 ❑ ]am exempt from Iicensure under the Contractors State License Law for t
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 which I must have resided for at least one year prior to completion
ss License Cla Ltcens No. eff 21 improvements covered by this permit I cannot legally sell a structure that I he
Expires Signalu built as an owner-bullding if it has not been consWcled In its entirety by licens
contractors.I understand that a copy of the applicable law.Section 7044 of I
WORKERS'COMPENSATION DECLARATION Business and Professions Code,Is available upon request when this applicetior
submitted or at the following Web she:
❑ I hereby affirm under penalty of perjury one the following declarations, httn:/A n leainfo.n.eov/mlaw.html.
I have and will maintain a certificate of consentt for workers;of self-Insure for workers'
compensation,issued by the Directnr of Industrial Relations as provided for by Date
Section 3700 of the Labor Code,far 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' co owner or authorized to act on the property owners behalf. I have lead t
compensation Insurance, as required is application and the Information I have provided Is correct 1 agree to com.
section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.My workers'compensation insurance canter and policy 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 abor
Carder !� p (� identified property for the Inspection purposes.
Policy#I G /b�r I Z Expires O'— "— ;! Date
Property Owner crAuthorized Agent �/�,(This section need not be completed IF the permit is for City Business License# 0 J ✓W79
one-hundred dollars($100)or less)
4 1 certify that in the performance of the work for which this permit Is Issued,I HAZARDOUS MATERIAL DECLARATION
shall not emlid 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 N 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 wi mply with those provigsions. [7' ❑YES 5p
Appli nt• Date; �r C� 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 KIND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility bewithin 1000 feel of the out
DAMAGES AS PROVIDED FOR 1IN SECTION 3706 OF THE bounder f a school?
LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES
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 C94e,Section 25505 and 25534 conreming
3097 Civil Code) hazardous mate ?7�
OWNER BUILDER DECLARATIONS DYES
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date a7- ..
License Law for the reason(s)indicated below by the checkmark(s)I have placed PRO OdNkP4 AUTHORIZED AGENT
next to the applicable ftem(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 IRRPI
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 Stale 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 RRPcerffied firms and comply with
she is exempt from Soensure.and the basis fdr the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant fora permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($5004 employees.For more information about EPA's Renovation Program visit:
El I, as owner of the roe www.epa.govAead or contact the National Lead Information Center at
p p rty, or my employees with wages as their sole 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 prolec
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.:
❑ 1, as owner of the property-an exclusively contracting with licensed 0 No EPA Lead-Safe Certified Finn Is required for this project because:
contactors to construct the project YSectton 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 '.
• • • P
"~Menifee
DATE 8-I(r PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL )4 RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLTTION O ELECTRICAL XMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Fl-C N-ec.v /CAI 3 -o +by-) '
I S EeYZ �P-LI 100 SI Le .2 5/� Lo
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER 33�-(3 � ��5� LOT Z,o ? TRACT
OWNER NAME
ADDRESS f CA,,J /�_ S..
PHONE(g5L) -/- 7-7/,-,to EMAIL
APPLICANT NNA/M�E a y- n + 1 Vt� /� /��p�p /��/�Q
ADDRESS �cX�J / _}On I/�v l V�y1�f M fr� l 1 Lf CA L" 2'5
PHONE (61Jl ) IP (/"lam--1502 p EMAILI' OnKSOIr'9D 1'YwL:d - cbm
CONTRACTOR'S NAME 1..1 r J.1 OWNER BUILDER? OYES NO
//��,,
BUSINESS NAME c it L. ndi �on I
ADDRESS S Men(fine— q25
PHONE l 75j� ( 70r EMAIL mbnl_Sciir Z GlvY-IA;,L • GDrn
CONTRACTOR'S STATE LIC NUMBER q IZ 1 q LICENSE CLASSIFICATION CZ.Q
VALUATION$ (o , 10 - SO.Fr ( �,�Z L SO FT
APPUCANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN f ! SMIP J
INVOICE . f (U PAIDAMOUNT
AMOUNT L•�- O CASH O CNECK R O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECKM 0CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES 0 NO DL NUMBER NOTARIZED LETTER O YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-62 2-6777
www.citycfinenifee.us Inspection Request Line 951-246-6213
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