PMT16-01906 City of Menifee Permit No.: PMT16-01906
29714 HAUN RD.
<ACCIi MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE Date Issued:
06/17/2016
PERMIT
Site Address: 26050 GLENHAVEN PL, MENIFEE, CA Parcel Number: 360-040-009
92584 Construction Cost: $15,000,00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT FOR 2 SYSTEMS,60,000 BTU COOLING AND 100,000 BTU FURNACE,36,000
Work: BTU COOLING AND 50,000 BTU FURNACE
Owner Contractor
NINA MEDINA RIZZO HEATING&AIR CONDITIONING
26050 GLENHAVEN PLACE 29092 RAMBLING BROOKS CT
MENIFEE,CA 92584 MENIFEE,CA 92585
Applicant Phone: 9516720397
ROXANNE EASLEY License Number:349958
RIZZO HEATING&AIR CONDITIONING
29092 RAMBLING BROOKS CT
MENIFEE, CA 92585
Fee Description Qty, Amount fbl
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_Permit_Template.rpl Page 1 of 1
CITY OF MENIFEE
/ LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that 1 am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from Rcensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class ems By my signature below I acknowledge that,except for my personal residence
Expires _Signature in which l must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
o I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for workers 7D44 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which www.leginfo.ca.gov/caIaw.htmI.permit is Issued.
Policy# Date
)4have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 370D of the Labor Code,for the performance of the work for which �y_my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and polity owner or authorized to act on the property owners behalf.1 have read this
number re• application and the information I have provided is correct.I agree to comply
��,L �t with all applicable city and county ordinances and state laws relating to
Carrier_ �Y1 f{ A t �� � n construction.I authorize representatives of this city or county to
Polity# I siU_ /. Expires 1 oires ' i1.,y terthe a v identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
Date
dollars($100)or less
PROPERTY OWNER ORAU 12ED AGENT
❑I certify that in the performance of the work forwhich this permit is issued, �(``��
I shall not employ any persons in any manner so as to become subjectto the CITY BUSINESS LICENSE# V��
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I swit t mpl with those provisions. Will the applicant or future building occupant handle hazardous material or
Applicant Date U'1�•1 mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECUR RKER'S COMPENSATION COVERAGE IS o Yes k o
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCtionor modification
permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY D Yes N0
I hereby affirm that under the penalty of perjury there is a constmction Will the proposed building or modified facility be within 1000 feet of the
lending agency forthe performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) o Yes Rio
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjurythat I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Heal Cade,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.S hazardo materia epord
Business and Professions Code).Any city or county that requires a permit to Ins .I�•I I /1
construct,alter,improve,demolish or repair any structure,prior to its Date U/
issuance,also requires the applicant for the permitto file a signed statement PROPERTY OWNER OR AUTHORIZE
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a D An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. D No EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement
BUILDING i SAFETY PERMIT/PLAN CHECK APPLICATION
e.
Menifee
DATE PERMIT/PLAN CHECK NUMBER `Q '
TYPE: O COMMERCIAL AMDENTIAL O MULTI-FAMILY O MOBILE HOME OPOOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL ,,, CHANICAL
O NEW O rrPLUMBING O RE-ROOF-NUMBER OF SSQUARES�y�/��
DESCRIPTION OF WORK V V — 2 v -C/f �wiifloYAU-
C I - 1 2 OG 16 - WOK
PROJECTADD SS
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME ,'.,/` Cify Of Menifee
ADDRESS 26U (J &1tn t\U ul Ing
PHONE ��/h EMAIL JU
APPLICANT NAME [�C/Q
r ,
ADDRESS ,r(�
PHONE 1 ( r EMAIL 'f v 'o, � �,1 C, '•/" "
CONTRACTOR'S NAME OWNER BUILDER? OYES O
BUSINESS NAME C',
ADDRESS &A
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER Y I 66 LICENSE CLASSIFICATION CZ
VALUATION$ '�-' SQ FT L SO FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP X
INVOICE 1 PAID AMOUNT
AMOUNT 'lO �' `V OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# 0CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O 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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