PMT18-04920 City of Menifee Permit No.: PMT18-04920
29714 HAUN RD. Type: Residential Mechanical
1 0 MENIFEE,CA 92586
MENIFEE MENIFEE Date Issued: 10/09/2018
PERMIT
Site Address: 28627 BRADLEY RD,MENIFEE, CA Parcel Number: 337-374-013
92586 Construction Cost: $7,678.63
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, CARRIER 3.5 TON, 14 SEER, R410A, SINGLE STAGE SPLIT A/C W/70,000
Work: BTU FURNACE
Owner Contractor
VERNON SWOPE MONK'S AIR CONDITIONING
28627 BRADLEY RD P O BOX 128
MENIFEE, CA 92586 SUN CITY,CA 92586
Applicant Phone:9516794502
GARY MONK License Number:912194
MONK'S AIR CONDITIONING
P0 BOX 128
SUN CITY,CA 92586
Fee Description 21 Amount 1$)
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 ❑ 1 am exempt from ficensure under the Contractors'State License Law for 0
following reason:
I hereby atfirtn under penalty or perjury that I am licensed under provisions of
Chapter g(wmmencing 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 e0 which I must have resided for at least one year prior to completion
License Class_r,Ucens No. _ improvements covered by this permit,I cannot legally sell a structure that I hat
Expires��3 i' � Signatu bulll as an owner-building If it has not been constructed In Its entirely by Ilcensi
wnhadors.1 understand that a copy of the applicable law,Section 7044 of 0
WORKERS'COMPENSATION QECLARATION Business and Professions Code,is avallable upon request when this application
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: htti3:th +.leainfo.m.aovlcalaw.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 Dale
Section 3700 of the Labor Code,for the performance of work for which this
permit is Issued. Property Owner orAuthorized Agent
Policy# ❑ By my Signature below,1 certify to each of the following:I am the proper
112( 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 th
section 3700 of the Labor Code, for the performance of the work for which this application and the Information I have provided Is cared. I agree to comp
permit is issued.My workers compensation Insurance artier and policy number are: with all applicable city and county ordinances and state laws relating to buildii
CC,�. . construction.I authorize representatives of this city or county to enter the abov
Cartier e-� F Q Q` Identified property for the inspection purposes.
Policy#12-700- /2 Expires — — y Dale
Properly Omer orAulhorized Agent /�.,
(This section need otone-hundred dollars($100)or less)be completed If the permit Is for City Business License# 035607$
41 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 pacified on the Hazardous Materials Information Guide?
Code,I shall t h ' mply with those provisions. ❑YESNO
Appll nl' Date; Will the Inlended.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' CoaslAir Quality Management Disbirt(SCAOMD)?See permitting checkiiE
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines '
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OYES <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 bewithin 1000 feel of the outr
DAMAGES AS PROVIDED FOR IIN SECTION 3706 OF THE bounds of a school?
LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
hereby aRrm that under the penalty of perjury there Is a construction lending pem fitting checklist I understand my requirements under the State of
agency for the performance of the work which this permit is issued(Section California Hear Safety Cyy e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mate A,
re orti 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 reason(s)Indicated below by the chedunark(s)I have placed PROkffK041NIko 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 fRRP1
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 ficersed pursuant to the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State Ucense Law(Chapter 9(commencing with receiving compensation for most work that disturbs paint In a pre-1978
Section 7000).of Division 3 of the-Businpzs and Professions Code)or that he or residence or childcare facility,to be RRP-certified firms and comply with
she Is exempt from Jlcensure,and the basis for 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($500).) employees.For more Information about EPA's Renovation Program visit:
www.epa.govAead or contact the National Lead Information Center at
❑ I, as owner of the property, 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 ❑An EPA Lead-Safe Cerlffed Renovator will be responsible for this project
who, through employees'or persona: 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). Flan Certification No.:
13
❑ I, as owner of the property an excluslvely contracfing with licensed No EPA Lead-Safe Certified Firm Is required for this project because:
contactors to construct the project(Section 7044.Business and Professions -
Code:The Contractor's License Law does not apply Id an owner of a property
who builds or Improves thereon, and who contracts for the projects with a
1:-.-..-..J ,.��...I.\�..�..-����,\ n , � Pam, 1 ,�...\ If..n..-�.n.�J J •���I....�u.r•n� nn1\�., I C,l�..,,L�OOfI
APPLICATIONBUILDING &SAFETY PERIVIIT/�LAN CHECK
��Menifee
DATE j PERMIT/PLAN CHECK NUMBER r
TYPE: O COMMERCIAL X RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL KMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES rn
DESCRIPTION OF WORK /t`C_ O d .J 'L� SEW,
PROJECTADDRESSGj2�
ASSESSOR'S PARCEL NUMBER 33i-33-��\3 "i LOT ��� TRACLj
OWNER NAME �r �` - , CC:Building Dept.
ADDRESS .0 ,/
PHONE (�5l )2 y /`'% .��/ EMAIL Received
{p,��q ^Q
APPLICANTNAME L„� A ® cei V `/
ADDRESS3�5 30 M Mr M tr_ I fee GA t �N
PHONE (/q5 ) (P7 l —Lf502 EMAILrrion K_c)a i r tD 0 rwL)_I • (�,✓Y1
CONTRACTOR'S NAME C:T)I r M C)rLK OWNER BUILDER? 0 YES hO
BUSINESS NAME C MnriV,'� l r Cbnd► b ml
ADDRESS /� J/�L/y C,�•� ( GA ��ZS
PHONE (q5I� 6; 1`�f 4 X/'�J/ _ /� EMAIL mbnkscit r) 0 rL06_l- - GDm
CONTRACTOR'S STATE LIC NUMBER `�/!2 j L1 LICENSE CLASSIFICATION Cz,0
VALUATIONS ' SO,FT , L SQ FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ® CITY OF MENIFEE BUSINESS LICENSE NUMBER
BURRING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE /��7_ FAIDAMOUNT
AMOUNT ;5a OCASH CCHECKC OCRE011'CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDrr CARD VISAIMC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LEMR 0 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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