PMT18-05085 City of Menifee Permit No.: PMT18-05085
MENIFEE,
EE, C 92 Type: Residential Mechanical
AV
MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued: 10/23/2018
PERMIT
Site Address: 29680 KINGSTON CT,MENIFEE, CA Parcel Number: 340-123-027
92584 Construction cost: $6,319.13
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT 3.0 TONS, 14 SEER 70K BTU FURNACE HEATING AND AIR CONDITIONING
Work:
Owner Contractor
ARLENE MICHALOVITZ MONK'S AIR CONDITIONING
29680 KINGSTON CT P O BOX 128
MENIFEE, CA 92584 SUN CITY,CA 92586
Applicant Phone:9516794502
GARY MONK License Number:912194
MONK'S AIR CONDITIONING
P 0 BOX 128
SUN CITY, CA 92586
Fee Description Oft Amount f$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_Pemiit Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ ]am exempt from licensure under the Contractors'State License Law for I
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 qa(1 license is in full force and&eff which I must have resided for at least one year prior to completion
License Class (� Licens No. improvements covered by this permit, I cannot legally sell a structure that I ha
Expires'3_ _1W Signatu< built as an owner-building If It has not been constructed in its entirety by[loans
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
❑ I hereby affirm under penalty of perjury one the following declarations,
I have and will maintain a rtthc:.te of consent
for workers; submitted or at the following Web site:
ce of self-insure for workers' httpl vnleginfo ca gov/mlaw html.
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 props
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 t
section 3700 of the labor Code, for the performance of the work for which this application and the Information I have provided is aorecL I agree to cam
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
C� construction.I authorize representatives of this city or county to enter the abet
Carrier / Q (� identified property for the inspection purposes.
Policy#12-_ 6W- / 2 Expires U — — -1 Date
Property Owner or Authorized Agent 2 (�(This section need Dot be completed If the permit is for C Business License# O351v-7 a one-hundred dollars($100)or less) kY
4 1 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 equ 31 to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts edfied on the Hazardous Materials Information Guide?
Code,I shall hwi mply with those provisions.
may}/,,I yry DYES
N 0
Appli nY Date; [`' I V ` U 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 =OR IN SECTION 3706 OF THE bounder
of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑YES VNO
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¢A Safety CRyyyy9dIe,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mau l re orti
OWNER BUILDER DECLARATIONS DYES NO Data 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 OdNAd.P4 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 fRRP)
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 RRPcerti5ed 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 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.gov/lead 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 Slate 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 contracting with licensed 11 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 td an owner of a property -
who builds or improves thereon, and who contracts for the projects with a
BUILDING
"IRMenifee
DATE PERMIT/PLAN CHECK NUMBER 0
TYPE: O COMMERCIAL )(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
yDESCRIPTION OF WORK PtC D .0
K _ PC
c rr
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER S\Ao L�3 aZ 9 LOT j -21 TRACT ZZ\ 32
OWNERNAMEE J e LC J (As h -o 1cjV l "/ (_-
ADDRESS JCl YY1 P. OI J/. ACC(
PHONE (�i 5� (ol t -, I4 7'�l /5 ��EMAIL
'APPLICANT2NAMME ��r^y^ a vt�Q V, /�p �pO /+,� �j�J�p
ADDRESS �,Jl 6 —}O 1�jv! lJM1 F I " l-.f I l 1 et CA "1` 5
Lt
PHONE (RV) �P (/��' 7 S` I,SGy� / EMAILrrionKSA I r'tV A IY aij - CA"n
CONTRACTOR'S NAME 1 V I OWNER BUILDER? OYES NO
BUSINESS NAME
ADDRESS S ( GA qZS
PHONE R5 q:�: 45n2 /� EMAIL ►V IGn kSu1r a7 Girr%a;_L . cam
CONTRACTOR'S STATC n
2LIC NUMBER `�//Z IL � LICENSE CLASSIFICATION CZ..Q
VALUATION$ 3 13 51:1 FT Z' -;:t3 L SQ FT �I
APPLICANTS SIGNATURE DATE " 1
ONLY,CITY STAFF USE
DEPARTMENT DISTRIBUTION C"OF MENIFEE BUSINESS UCENSE NUMBER
BuiLoiNG PLANNING ENGINEERING FIRE I GREEN I. SMIP
INVOICE ppiD AMOUNT
AMOUNT • O CASH O CHECK# O CREDI,CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# 0CREOF CARD MSA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O TES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
5��o-�at 1�c1
O o 6 in LWj N
¢ m •�.� o o a c '.'.
Adi
-
¢ N
C a
0
E c c v 3
0 m — 1- °
U o o m T Z C
C C U
N
N T N a K
E E � 3 r.
a o o m a E
m
'G N al r m T '^ O
m c u_ o ° T Z
c � in
a ° •N o r• N
« a a £ a u
E "2 N 1O
E •O � a E
0 o co o c a c
O inLL Z u Y o ° }
3 y E N
o f
fp a mho N M 0
ci
C C C C N O C � vui
m a y
C
3 fO m « mo > m O
O N ` ° E c U
c u 0 0 a
u i7 in
v m u E
o
x u u air.
¢ E G L E u a N LL C
U U R o u
T c c = p —
0
£ y Y ] N a O C
O y a H M Y a
C 0
'0
U -E Y N E O N Y a rl a O 41
N V p L m C W 4O. LL .O T p m
v
u lD Vl N
h a w a i N a
pp o. 3 Y T m a
� L �• aa+ 'o c Y � 'o
c uI
o E
Z = o U o u O a O O N Yn
J ° m C
a u C p Y m a
G a U a O •C J N N V
0 u E —
£ a a G X
V N i d
LL vai w m Q Z ? N
a a c c L a
W Y £ N N V V Y °
u o Z n o >u E
LL N y C ¢ ¢ O. m u N u f0 U N Z T aa+ m a
�C
L) 6 a` Q u L)