PMT15-01212 i
i
City of Menifee Permit No.: PMT16-01212
29714 MENIFEE,
CA 92586 Type: Residential Mechanical
�iCG�L.Y�k." C' 92
MENIFEE Date Issued: 05/08/2016
a
PERMIT
1
Site Address: 28195 ASPENWOOD WAY, MENIFEE, Parcel Number: 372-024-003
CA 92584 Construction Cost: $10,000.00 �II
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i
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT 60,000 BTU COOL, 100,000 BTU HEAT
Work:
Owner Contractor
LARRY NACHTMANN RIZZO HEATING&AIR CONDITIONING
28195 ASPENWOOD WAY 27062 BRISTOL LANE
MENIFEE, CA 92584 MENIFEE, CA 92584
Applicant Phone: 9516720397
ROXANNE EASLEY License Number: 349958
RIZZO HEATING&AIR CONDITIONING
27062 BRISTOL LANE
MENIFEE, CA 92584
Fee Description C111y. Amount Isl
Forced Air or`GravltyType Furnace or burner , wµz qy 1 149 00t
Air Handling/Condensing Units SFR 1- 133.00
�Bulldl�g Permit Issuance A '�� v 4 1 i; �, � 2�7 00'$
GREENFEE- - -� � 1� - - 1.00�
$310.00
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
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9 (commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Code - y license is in ful rce ct. Code:The Contractor's License Law does not apply to an owner of a property
License C,la�-sus Licen e-N who builds or improves thereon, and who contracts for the projects with a
Expiresit-❑.J Signature _ licensed contractors)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARA
❑ I am exempt from licensure under the Contractors'State License Law for the
❑ I hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in
_ compensation, issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have
permit is issued. built as an owner-building if it has not been constructed in its entirety by licensed
Policy# contractors. I understand that a copy of the applicable law, Section 7044 of the
14 1 have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http'//www.leciinfo.ca.ciQv/calaw.html.
permit Is issued.My workers'compensation Insurance carrier and policy number are:
}���p� tr,\1�. Property Owner or Authorized Agent Date
Carrier VVlJ�Ak1 V
Expires Policy t'`O�"`•" ����1
rdBy my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# - owner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
construction. I authorize representatives of this city or county to enter the above-
�' that in the performance of the work for which this permit is issued, I Identified_pl'o arty for the inspection purposes.
1 not employ any persons in any manner so as to become subject to the <'.
workers' compensation laws of California, and agree that if 1 should become - �I
subject to the workers'compensation provisions of Section 3700 of the Labor property Owner or u rized Agent Date
Code,I shall forthwith comply withfose-provisi ns.
S l_ City Business License# Don-
V n- �0
Date; 1 Applicartlt(`
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
_ COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($700,000), IN ADDITION TO THE COST OF COMPENSATION, ra,-pES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending
INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name ')kES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ❑NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed Xf S WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s)(Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, ❑NO SCHOOL?
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 I HAVE READ THE HAZARDOUS MATERIAL
provisions of the Contractor's State License Law (Chapter 9 (commencing with
Section 7000)of Division 3 of the Business and Professions Code)or that he or DYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to AD UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than ($500).) CODE
SECDOUS MATERIAL 255051';E5533 GD 25534 CONCERNING
El 1, as owner of the property, or my employees with wages as their sole
compensation, will ( )all of or( ) porting of the work, and the structure is tPROPE OW IER AUTHORIZED AGENT
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 X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale. If,however,
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).
& SAFETY PERMIT/PLAN CHECK APPLICATION
kMenifee
DATE CJ 15 PERMIT/PLAN CHECK NUMBER QM 1rj Olaf
TYPE: O COMMERCIAL ' SIDENTIAL (-," MULTI-FAMILY C', MOBILE HOME O POOL/SPA '>SIGN
SUBTYPE: 0 ADDITION %ALTERATION `0 DEMOLITION 0 ELECTRICAL MECHANICAL
C? NEW C: PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK ��1 1 1 Cl
y�1 I uun ow m"
wolmn
1
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER J�a' ^ LOT JILA TRACT
OWNER NAME UU VQMy ^',`. W)
ADDRESS ` .q" 1
PHONE S� @ LAQ V rj " EMAIL
APPLICANT NAME 1 u U41W
ADDRESS t��,�(A`n n`,
PHONE �i �1 ,�� EMAIL YV�M ff . ems vj , I
CONTRACTOR'S NAME 1l/�' ('V�1.-/Y�iQ/4�2 OWNER BUILDER? CO YES . 0
BUSINESS NAME �/ ` 1(.
ADDRESS CA2, A,\ IVVN
PHONE W2 (&W 11 EMAIL LZO Vrc0 V 7w -at
CONTRACTOR'S STATE LIC NUMBER oflS(Jn LICENSE CLASSIFICATION
VALUATION $ SO FT L SQ FFTT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN $MIP
INVOICE I N PAID AMOUNT
AMOUNT O ; CASH %CHECK# '.)CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CASH v`.CHECK# `CREDIT CARD VISA/MC
OWNERBUILDERVERIFIED YES 0 NO DLNUMBER NOTARIZED LETTER YES NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menefee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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