PMT15-01915 1
City of Menifee Permit No.: PMT15-01915
29714 HAUN RD.
-tCl. MENIFEE, CA 92586 Type: Residential Mechanical
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MENIFEE Date Issued: 07/07/2015
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PERMIT
Site Address: 28764 RAINTREE, MENIFEE, CA 92584 Parcel Number: 340-210-010
Construction Cost: $9,000.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT, 60,000 BTU A/C, 100,000 BTU FURNACE
Work:
Owner Contractor
JOE NIESNER RIZZO HEATING&AIR CONDITIONING
28764 RAINTREE 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 QtV Amount l$1
Air Handling/Condensing Units SFR 1 133.00
GREEN FEE 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_Bidg Permit_Template.rpt Page 1 of 1
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City Of Menifee 1
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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 and my lic M�trr ul ffor an(�jffect. Code:The Contractor's License Law does not apply to an owner of a property
License C ass�a _L e .}/ who builds or improves thereon, and who contracts for the projects with a
Expires Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION a
❑ I am exempt from Iicensure under the Contractors'State License Law for the I
❑ 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 3ssu of the Labor Code, for the performance of work for which this improvements covered b this permit, I cannot legally sell a structure that I have
permit is issued. � p Y p 9 Y
Policy# built as an owner-building If It has not been .constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law, Section 7044 of the
❑ I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is avallable 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;ILwwmleainfo caoov/calawhtml.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier ��t,\ Property Owner or Authorize Agent
Date
Expires
Name of Agent Phone# ❑ By my Signature below, I certify to each of the following: I am the property
owner or authorized to act on the property owner's behalf. I have read this
(This section need noi 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) wi . 1 p able city and county ordinances and state laws relating to building
canst uctio .I authorize representatives of this city or county to enter fhe above-
❑ I certify that y the performance the work for which this permit is issued,I ide li . pro y-f r the inspection purposes.
shall not employ any persons in any
manner so as to become subject to the
workers' compensation laws of California,��apr�Lz ree that If I should become
subject to the workers'compensatio99,,pp visions o Section 3700 of the Labor Property Owner or Authorized Agent Date Code, I shall forthwith comply withsf£ese ision .
�r�'
F
,�-�' City Business License#
Date; �� l"w, Applicant;
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
($100,000), IN ADDITION TO THE COST OF COMPENSATION, []YES OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706'0F THE. MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ENO 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 - DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
N0 DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS GUIDE LINES
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 ❑YES 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, \pN0 SCHOOL?
or repair any structure, prior to its issuance, also requires the applicant for the Z`
permit to file a signed statement that he or she is licensed pursuant to the
provisions of the Contractor's State License Law (Chapter 9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or AYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from Iicensure 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 NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION 25505. 25533 AND 25534 CONCERNING
❑ 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORYING.
compensation,will do ( ) all of or( ) porting of the work, and the structure is i- PR02ERTy11N/1j R AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code; v-The Contractor's State License Law does not apply.to an owner of a property
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
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APPLICATION& SAFETY PERM IT/PLAN CHECK
�,.tJ`.
Menifee
DATE V PERMIT/PLAN CHECK NUMBER — Q1q r'
TYPE: O COMMERCIAL '. ESIDENTIAL " MULTI-FAMILY 10 MOBILE HOME % POOL/SPA Ci SIGN
SUBTYPE: C%ADDITION 0ALTERATION DEMOLITION C? ELECTRICAL ^ECHANICAL
C% NEW " PLUMBING 0RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 1pi Ar u
llA1
PROJECTADDRESS IM4 �Rolftwe_-e
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNERNAME
ADDRESS �j
PHONE C10Ic EMAIL
APPLICANT NAME /p� //��q��Q
ADDRESS _ L C&-6
PHONE C� EMAIL Gba_-10
CONTRACTOR'S NAME OWNER BUILDER? YES 0
BUSINESS NAAJ �M( �1
ADDRESS Lam" " 12—
qc�l �
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER • S1 Mq�3�/ LICENSE CLASSIFICATION Z
ArN
VALUATION$ FT "L �' L SO FT
APPLICANT'S SIGNATURE DATE
CITYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 1 SMIP X
INVOICE PAID AMOUNT
AMOUNT O <% CASH 0CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT C)CASH %CHECK# <.%CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED '%YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES - NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951.672-6777
www.cityofinenifee.us Inspection Request Line 951-246-5213
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