PMT19-00071 City of Menifee Permit No: PMT19-00071
29714 HAUN RD
A& MENIFEEF , CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued:
01/07/2019
PERMIT
Site Address: 27663 CAMDEN WAY, MENIFEE 92586 Parcel Number: 335-211-009
— Construction Cost: $9,545.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE HVAC; INSTALL AMERICAN STANDARD 3 5 TON, OVER/UNDER PACKAGE
Work: HEAT PUMP
Owner Contractor
SANDRA WASHINGSTON MONK'S AIR CONDITIONING
27663 CAMDEN WAY P O BOX 128
MENIFEE, CA 92586 SUN CITY, CA 92586
Applicant
GARY MONK Phone: 9516794502
MONK'S AIR CONDITIONING License Number: 912194
P O BOX 128
SUN CITY, CA 92586
Phone: (951)679-4502
Fee Descrl lion —- —
�t Amount
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
HVAC Replacement 9 152,60
General Plan Maintenance Fee-Mechanical 1 0.00
$180.60
The issuance of this permit shall not prevent the building official from(hereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no wont is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Permit_Template rpt
Page 1 of 1
BUILDING & SAFFTY PERMIT/PLAN CHECK AP •
. ,Menifee
DATE Z�2 -�� PERMIT/PLAN CHECK NIMSEgfWltl '
TYPE: O COMMERCIAL )L RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL XMECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORKJhL,&C_
bll-
PROJECTADDRESS 2 " t.��
ASSESSOR'S PARCEL NUMBER -3 3 QU G ---kA-Mj �� TRACT �1\A
0' ` " � silty Ot
OWNER NAME V Vl� j aft
ADDRESS _�_ � •� l_ Cti.�J ��LZ.-� AN all n`i' ant
PHONE 64,51 '7 EMAIL
APPLICANT NAME r upmk— R
ADDRESS �J C) V r" � i �� 01- �L 5
/�5 I / /� f�.......
PHONE ( mtr�
` (CP 7-Lf50. EMAILA-l0nKS0!N'tV rYW jj • C&n
__CONTRACTQR'S NAME C- ru OWNER B_»ILDERT O `DES NO
BUSINESS NAME � &l r .O
ADDRESS [ cl-2J
PHONE g5l7 �-1 s EMAIL nnOn ks "!r cc7 rna.�d, , c o m
kJ
CONTRACTOR'S STATE LIC NUMBER C/I2 IgLI LICENSE CLASSIFICATION cz-
VALUATION$ G ,5LJ 5. O b sQ FT L SQ FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION q77`7
EE BUSINESS LICENSE NUMBER
BUILDING A NING ENGINEERING FIRE 7,6GRE7ENN SMIP
7
INVOICE PAID AMOUNT
h - /„�
AMOUNT �f �d4 O CASH 0CHECK# O CREDITCARD VI_WMC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD MSA/MC
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 951-67?-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
City Of Menifee
LICENSED DECLARATIOfU ❑ 1 am exempt from licensure under the Contractors'State License Law for t
I hereby affirm under penalty or perjury that 1 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 �y license is in full force and eff t. which I must have resided for at least o ie year prior to completion
License Class � L1 Licerls No. improvements covered by this permit, I cannot legally sell a structure that I ha
Expires Signatu built as an owner-building if It has not been constructed In its entirety by licens
contractors. I understand that a copy of the applicable law, Section 7044 of t
WORKERS'COMPENSAT ECLARATIO 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 of the following declarations: ham. fitted r at the o following
site:
I have and will maintain a certificate of consent of self-Insure for workers' _
i.
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
V, I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property ow'ner'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
C construction.I authorize representatives of this city or county to enter the abo%
Carrier 4 / Q identified property for the inspection purposes.
Policy# 2^_ [J�r 2 Expires U J �� _ Date
Property Owner or Authorized Agent
(This section need not be completed if the permit is for � +
one-hundred dollars($100)or less) City Business License#
I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATIQN
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 Califomia, 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 ecified on the Hazardous Materials Information Guide?
Code,I shall f hwl mply with those provisions.
p
i�/ �v/I YES NO
Appli ant' _ Date; ` `— 6 a 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 ❑YES 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 oe within 1000 feet of the out
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounda of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES AYES NO
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.C e,Section 25505 and 25534 concerning
3097 Civil Code) hazardous mate I re orti
❑YES NO� l 7 le
OWNER BUILDER DECLARATIONS Date r�� �4 �
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 O N 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 RENOVA11 N,REPAIR AND PA[NT!JG RRI'
or repair any structure, prior to its issuarnce, 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 facility to be RRP-certified 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 7031.5 by any Applicant for.a 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',Renovation Program visit:
❑ I, as owner of theproperty, or m em to employees with wages as their sole www.epa.gov/lead or contact the National Lead Information Center at
y p y g 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 Certified Renovator will be responsible for this project
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). Firm Certification No.:
"
❑ I, as owner of the property-an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Firm is required for this project because:
contractors 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
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