PMT15-01918 i
City of Menifee Permit No.: PMT15-01918
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued: 07/07/2016
PERMIT
i
Site Address: 31021 DURHAM DR, MENIFEE, CA 92584 Parcel Number: 372-472-006
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
TIKIA JACKSON RIZZO HEATING&AIR CONDITIONING
31021 DURHAM DRIVE 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 Oyt Amount is
Air Handling/Condensing Units SFR 1 133.00
I `
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 slated, 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
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 Ilc ul forf�,,�-n ffect. Code:The Contractor's License Law does not apply to an owner of a property
License Cass�Li e `7�� 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 licensors 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 3 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. built as an owner-building y if it has not been constructed in its entiretyb licensed
Policy# contractors. I understand that a copy of the applicable law, Section 7044of 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:http'//www leginfo ca gov/calaw html.
permit Is Issued.My workers'compensation insurance carrier and policy number are:
Carrier �tj kA&-> (.t3 Property Owner or ut oozed Agent Date
Expires AZ IC{ Policy# G� LV�'�V�2G-%
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 IYaa pl 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-
❑ 1 certify that in the performance of the work for which this permit is issued, Iids ti ie- pro f r the inspection purposes.
shall not emolov any persons in any manner so as to become subject to the
workers' compensation laws of CalifornW
ould become 1
subject to the workers'compensatioryry.�ppr of the Labor pro ert Owner or Authorized A Code,I shall forthwith comply with�ase P Y gent Date
City Business License#
Date; ��� f Applicant; _
1.
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, DYES OCCUPANT HANDLE AHAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE. MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST AND ATTORNEYS FEES `EtNO 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
FNO 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, \D_NO 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 DYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any t. CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to rrNO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) l 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 _ 2Eary nrnrniFR 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 .=may 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
J j4
Menifee
DATE / PERMIT/PLAN CHECK NUMBER 0
TYPE: '.:`. COMMERCIAL /RESIDENTIAL `i MULTI-FAMILY (C% MOBILE HOME C POOL/SPA SIGN
SUBTYPE: " ADDITION ()ALTERATION O DEMOLITION '" ELECTRICAL (MECHANICAL
<; NEW CD PLUMBING ORE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK ,m{{yc�'�
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER 31a LOT TRACT
OWNER NAME
ADDRESS
PHONE q, 1`6 �® EMAIL
APPLICANT NAME 1^
ADDRESS /W F✓ UJ S. C(V&
PHONE Ot;,,t 0001 _ EMAIL n ccryl
LSCONTRACTOR'S NAME OWNER BUILDER? C0 YES 0
BUSINESS NAME ry',y� G
ADDRESS 2 r'1 L— �1 'i
PHONE �1 U_y_ lzf EMAIL
CONTRACTOR'S STATE LIC NUMBER 6x LICENSE CLASSIFICATION (/Z
VALUATION $ IDW FT Fr)o LSQFTFT �I
APPLICANT'S SIGNATURE DATE 1� 1' I F5
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP X
INVOICE PAID AMOUNT
AMOUNT 1 O % CASH 'D CHECK# ='CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT C% CASH •-D CHECK# CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED DYES NO DLNUMBER NOTARIZED LETTER YES i.% NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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