PMT15-04033 City of Menifee Permit No.: PMT15-04033
29714 HAUN RD. Type: Residential Mechanical
<A-CCELA> MENIFEE, CA92586
MENIFEE Date Issued:
12I31I2015
PERMIT
Site Address: 27640 SANDTRAP DR, MENIFEE, CA Parcel Number: 335-243-001
92586 Construction Cost: $6,000.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT 36,000 BTU FURNACE AND A/C
Work:
Owner Contractor
FRANK CRACCHIOLO RIZZO HEATING&AIR CONDITIONING
27640 SANDTRAP DRIVE 29092 RAMBLING BROOKS CT
MENIFEE, CA 92586 MENIFEE,CA 92585
Applicant Phone:9516720397
ROXANNE EASLEY License Number 349958
RIZZO HEATING&AIR CONDITIONING
29092 RAMBLING BROOKS CT
MENIFEE, CA 92585
Fee Description O_yt Amount IEl
Forced-Air or Gravity-Type Furnace or Burner 1 149.00
Air Handling/Condensing Units SFR 1 133.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Mechanical 1 14.10
$324.10
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 Pennit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ I am exempt from licensure under the Contractors'State License Law for th(
I hereby affirm under penalty or perjury that I 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 Ir
Professions Code,a y license is in full force and which I must have resided for at least one year prior to completion o
License CI ss �C ni License No. S� improvements covered by this permit, I cannot legally sell a structure that I hav(
Expires 1 �.Y Signat I a built as an owner-building if it has not been constructed in its entirety by license(
contractors. I understand that a copy of the applicable law, Section 7044 of th(
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application i(
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: htto:/Mnvw.lepinfo.ce.aov/celaw.html.
I have and will maintain a certificate of consent of self-insure for workers'
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# 3y my Signature below, I certify to each of the following: I am the properb
,.( I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owners behalf. I have read thi:
'on 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 comph
permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to buildin(
V �/� construction.I authorize representatives of this city or county to enter the above
Carrier 1 Vl/lr (d ntlfied p party for the inspection purposes.
� ,,11 ' 2ol`P
Policy AA Expires Dale
P perty Owner or ' /dd Agent
(This section need not be completed If the permit is for City Business License# I Q Flap
one-hundred dollars($100)or less)
certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ any persons in any manner so as to became subject to the Will the applicant or future building occupant handle hazardous material or a
workers'compensation laws of California,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 specified on the Hazardous Materials Information Guide?
Code,I sh hwith comply with those provisions. DYES ).NO
A li Date; 12' I� 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: LURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES O
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the 6roposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES �AO
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&Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous t . I reporting.
OWNER BUILDER DECLARATIONS AYES (I zl 2 (�
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date 12 JI IS
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AkU6RIZED 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 RENOVATION,REPAIR AND PAINTING(RRP)
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 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 properly
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's Renovation Program visit:
❑ I, as owner of theproperty, or m ern to employees with wages as their sole www.epa.gov/lead or contact the National Lead Information Center at
Y P Y 9 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 Firm Certification No.:
purpose of sale).
Cl 1, 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 to an owner of a property
who builds or Improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
Ac4nnwlndncmonf
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE I2 ` I PERMIT/PLAN CHECK NUMBER 33
TYPE: O COMMERCIAL TP' DENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL )XNIECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
-0 13DESCRIPTION OF WORK COOI�
to I 5 '
PROJECTADDRESS 2luqo sow
ASSESSOR'S PARCELNUU�MBEyR( fn�p/l� 5•QQ LOT TRACT
OWNERNAM/E� �It'� p�`I n� 1\ UI(�i' I I C�
ADDRESS !i II L� 0 ( Y Building & Safety Dept.
PHONE "1 �.J' I EMAIL DEC 3 1 2015
APPLICANT NAMEwym (�Qf G
)n4 Received
ADDRESS//�� /�� 2
PHONE 01SI uol sl p.EEMAIL
VY CONTRACTOR'S NAME 70 t c� OWNER BUILDER? :%YES P(t40
BUSINESS NAME ((��,��
ADDRESS 2 I wIZ I` 1!6ymrS
PHONE CC). EMAIL /J
CONTRACTOR'S STATE31
LIC NUMBER 1491 LICENSE CLASSIFICATION LJw
VALUATION$ U SO FT L SO FT 2
APPLICANT'S SIGNATURE DATE Z'"J)•I S
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP M
INVOICE I PAID AMOUNT , O
AMOUNT . 1O 10 0CASH CHECK# OCREDITCARD VISAIMC
PLAN CHECK FEES PAID AMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER 0 YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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