PMT16-00989 City of Menifee Permit No.: PMT16-00989
29714 HAUN RD. Type: Residential Mechanical
-1;ACiCEEA—.' MENIFEE, CA 92586
MENIFEE Date Issued: 04/0412016
PERMIT
Site Address: 27641 SANDTRAP DR, MENIFEE, CA Parcel Number: 335-242-012
92586 Construction Cost: $6,500.00
Existing Use: Proposed Use:
Description of HVAC CHANGEOUT, PACKAGE UNIT
Work:
Owner Contractor
BRAD ROBARDS RIZZO HEATING&AIR CONDITIONING
27641 SANDTRAP DR 29092 RAMBLING BROOKS CT
MENIFEE, CA 92586 MENIFEE,CA 92585
Applicant Phone:9516720397
MIKE RIZZO License Number:349958
RIZZO HEATING&AIR CONDITIONING
29092 RAMBLING BROOKS CT
MENIFEE,CA 92585
Fee Description QQt t Amount
Forced-Air or Gravity-Type Fumace 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_Permit_Templalexpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from Ucensure under the Contractors'Stale License Law for IN
I hereby affirm under penalty or perjury that 1 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 it
Professions Gods y license is in futI force and c which I must have resided for at least one year prior to completion o
License Class 1(m rise No. S improvements covered by this permit,I cannot legally sell a structure that I have
Expires 20 �j Signal u a built as an owner-bullding if it has not been constructed in Its entirety by licenser
contractors.I understand that a copy of the applicable law.Section 7044 of IN
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application b
submitted or at the following Web site:
❑ I hereby affirm under penalty of perjury one of the following declarations: htio:/A w .leainfo.ca.eov/calaw.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# By my Signature below, I certify to each of the following:I am the propert!
p�(�, I have and will maintain workers' compensation Insurance, as required by owner or authorized to act on the property owner's behalf. I have read thi:
section 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 compl!
permit is issued.My workers'compensation insurance canter and policy number are: with all applicable city and county ordinances and slate laws relating to building
construction.I.authorize representatives of this city or county to enter the above
Carder 1 WY id nune-d p perty for the inspection purposes. _. , - (�4 I�(
Policy MW4yGr7n Expires Z v L --/-� Date
Pr ppeerty Owner orbWpdzeed�d Agent C'
(This section need not be completed if the permit is for City Business License#
one-hundred dollars($100)or less)
,,(/
1p�rcertify 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 become 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?
Cade,I sh hwith comply with those provisions. DYES 0
A li Date" lu�(� W:II the intended use of the building by the applicant or future building
occupant require a permit for the construction or modNcation from South
WARNING: LURE TO SECURE WORKERS' CoastAlr Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND []YES 'PNO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS r
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet ofthe outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES OYES NO
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 concemin
3097 Civil Code) hazardous
at reportingreporti . L�-(�N
OWNER BUILDER DECLARATIONS
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Oat Jl[ ,
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR A6TWRIZED 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 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 Slate License law(Chapter 9(commencing with receiving compensation for most work that disturbs paint In a pre4978
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 property
violation of Section 7031.5 by anyApplicanl 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 the roe wwwepa.gov,Aead or contact the National Lead Information Center at
of property. or my employees with wages s their sole 1-800-424-LEAD(5323).
compensation,will do( )all of or( ]porting of the work,and theeW structure Is
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's Stale 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 Ftmr Certification No.:
purpose of sale).
❑ 1, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe CeNfredFirm 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
AnlrnnwlcAnnmonr
& SAFETY PERM IT/PLAN CHECK APPLICATION
'Menifee
DATE c/ PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL (PRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION G ALTERATION O DEMOLITION O ELECTRICAL Q MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Okl\mq&6Lr Neli
PROJECT ADDRESS Z-)Gtl "7" JN-�Co-I aesg"oo
ASSESSOR'S PARCEL NUMBER 77J��� j�� LOT �a� TRACT +--7-`4-1
OWNERNAME StP0
ADDRESS Z-1cOLli �•-r/LRP G Q2S
PHONE EMAIL
APPLICANT NAMEE7 ,alze.
ADDRESS �J
PHONE 9Sr-G7Z• 03�� nq EMAIL ¢C7rW f�I�'/
05 g9 4141ag .e•:),
CONTRACTOR'S NAME
�� OWNER BUILDER? O YES O NO
BUSINESS NAME/�
ADDRESS //jj00,77rr7Z p�CA��t�' '7WdK5 �J
PHONE L(� &71- 6 W7 EMAIL Z/= Aov,0<' 4, +4`,10,) /J,��-�3�✓�
CONTRACTOR'S STATE
�LIC NUMBER I �jL�Y'",,A LICENSE CLASSIFICATION
C%
VALUATION$ o SO FT /��Dz) L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE •1Q PAID AMOUNT
AMOUNT 0CASH CCEECK# OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZEDLETTER 0 YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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