PMT15-01916 i
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City of Menifee Permit No.: PMT15-01916
29714 HAUN RD.
'�C'CEL—A MENIFEE, CA 92586 Type: Residential Mechanical
s asan,�P MENIFEE Date Issued: 07/07/2015 j
PERMIT
Site Address: 28739 AVENIDA ESTRELLA, MENIFEE, Parcel Number: 341-093-011
CA 92587 Construction Cost: $7,500.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT 30,000 BTU A/C, 36,000 BTU FURNACE
Work:
Owner Contractor
MONICA REICHEL RIZZO HEATING&AIR CONDITIONING
28739 AVENIDA ESTRELLA 27062 BRISTOL LANE
MENIFEE, CA 92587 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 I$1
r- r
Air Handling/Condensing Units SFR 1 133.00
a:
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 Bldg_Permit_Templatexpt Page 1 of 1
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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 I.
Professions Code and my tic rtsts't�lrrjul for an ffect. Code:The Contractor's License Law does not apply to an owner of a property j
License Cass��-r ' Li e 6 C-f:'r� 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
❑ 1 am exempt from Iicensure under the Contractors'State License Law for the
Cl 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 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
❑ 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:http7//www.leginfo.ca.gov/calow.html.
permit is Issued.My workers'compensation insurance carrier and policy number are:
Carrier L( V\Ls (_0 - Property Owner or Authorized Agent
�R p_ �1�7�7 Date
Expires 2 It,( Policy# p'_N VJ UM�i/ c.G
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 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) wi t-ap'7 able city and county ordinances and state laws relating to building
const uctio .I authorize representatives of this city or county to enter the above-
❑ I certify that in the performance of the work for which this permit is issued.,IIde ti ie pro r the Inspection purposes.
shall not emolov any persons in any manner so as to become subject to the
workers' compensation laws of California,.a ree that if should Become
subject to the workers'compensatiorr��..pp visions o Section 3700 of the Labor pro ert Owner or Authorized A e
Code,I shlIaII forth--with comply with:t-ase o ision P Y g nt Date
Date; Applicant; -� City Business License#
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, EYES OCCUPANT HANDLEA HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE. MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES `FARO - 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 ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
?lqO 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 reasons)indicated below by the checkmark(s)I have placed OYES 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, 4L7N0 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
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 OYES 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($500).) CODE, SECTION 25505, 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole - HAZARDOUS MATERIAL REPORTING.
compensation, will do ( )all of or( ) porting of the work, and the structure is ���''-'�'-�-�P-R OPER-TY-QIOINER AUTHORIZED AGENT
not Intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply.to an owner of a property F='�� X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
�.f Menifee
DATE PERMIT/PLAN CHECK NUMBER - q LQ
TYPE: O COMMERCIAL ESIDENTIAL C% MULTI-FAMILY i:: MOBILE HOME (:::' POOL/SPA ^SIGN
&
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION r�LECTRICAL O MECHANICAL
O NEW PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK —�
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER 3iA\- LOT TRACT
OWNER NAME 1OC"I
ADDRESS ft j '
tCACJ
PHONE �51 � i ``�EMAIL
APPLICANT NAME - �j I VV
n
ADDRESS !.
PHONE Wiz, EMAIL
CONTRACTOR'S NAME OWNER BUILDER? a YES VqO
BUSINESS NAME ®
ADDRESS(`��1�,r- L^ I (--
PHONE v 1v� �� L EMAIL /'�
CONTRACTOR'S STATE LIC NUMBER �Cl C
gst LICENSE CLASSIFICATION 2
VALUATION$ 1 SO FT J��� L SO FT
APPLICANT'S SIGNATURE DATEOTY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENJVISA/MC
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP x
INVOICE 1 PAID AMOUNT
AMOUNT 510 3i OCASH `%CHECK# 1CREDIT CARPLAN CHECK FEES PAID AMOUNT CASH %CHECK# %'CREDIT CAROWNER BUILDER VERIFIED YES , NO DL NUMBER NOTARIZED LETTER ) YES
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-245-5213
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