PMT16-02086 City of Menifee Permit No.: PMT16-02086
29714 HAUN RD. Type: Residential Mechanical
<ACCELAl7. MENIFEE, CA 92586
MENIFEE Date Issued:
U710112016
PERMIT
Site Address: 28919 BAYWATER DR, MENIFEE, CA Parcel Number: 340-190-078
92584 Construction Cost: $8,500.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT COOLING BTU 48,00 BTU, HEATING BTU 80,000 HEATER IN ATTIC
Work:
Owner Contractor
MYRNA MAXWELL RIZZO HEATING&AIR CONDITIONING
28919 BAYWATER DR 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 QQt V Amount ISI
Forced-Air or Gravity-Type Furnace or Bumer 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 staled,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 property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjurythat I 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 ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code'and my license is in full force and effect. the((77 the following reason:
License Clasps .C20 License No.�"I�'"IS By my signature below I acknowledge that,except for my personal residence
Expires 2—on Signature _ in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legallysell a structure that I
-WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
D 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 worker's 7044 of the Business and Professions Code,is available upon request when
compensation,issued bythe 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
this permit is issued. www.leeinfo.ra.Rov/calaw.htmL
Policy R Date
'II have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which �)aY my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: III application and the information I have provided is correct.I agree to comply
rCarrie o, A with all applicable city and county ordinances and state laws relating to
�� �� ,,ffwa��� ��t b ' ' construction.I authorize representatives of this city or county to
Policy RM\VVL1 1 "IExpires J9 enterthe abNe identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred — Date I
d..((o�lllars($100)or less PROPERTY OWNER OR UT RIZED AGENT
OYertify that in the performance of the work for which this permit is issued,
(shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE p �JIJ l
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, all rt i r comply with those provisions. Will the applicant or future building occupant handle hazardous material or
Applicant Date_ mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECUR KER'S COMPENSATION COVERAGE IS D Yes IONo
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($10D,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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidell es
CONSTRUCTION LENDING AGENCY D Yes ;K
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) ❑Yes xyNo
OWNER BUILDER DECLARATIONS 1 have read_the Hazardous Material Information Guldeand the SCAQMD
I hereby affirm under penalty of perjury that 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 Health&Safety Code,Section 25505 and 25534 concerning
hazardous mat na r H'
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 4iyes ❑No (( I n
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,priorto its PROPERTY OWNEROR AUTHORIZE A T
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 Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRP)
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))censure 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
o 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.eoa.eovAead or contact the National Lead Information Center at
not Intended or offered forsale.(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. o 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 & SAFETY PERMIT/PLAN CHECK A. r
Meniree
DATE I ' PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL I-<BESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O.ALTERATION O DEMOLITION O ELECTRICAL p@MECHANICAL
O NE`W/ O PLUMBING /,0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK k�V A & V 1 6 QD) 6,5b
FYI, h^i 1 ek
PROJECTADDRESSllci I °I� �iT7�' QVv*,T ,F Q C G
ASSESSOR'S PARCEL NUMBER 5� -60-01 LOT TRACT �"J�✓S4
OWNER NAME �/� r{�/�,1 ' VV)eA ,/
ADDRESS /Z yG1 G krn o JCArf
PHONE O1S{ �j A ',>' 1 [ D / EMAIL
APPLICANT NAME f�/! CAn W Cf
ADDRESS
PHONE QL� \U.(M S2L-
;4- EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES 0 NO
BUSINESS NAME
Z"I ADDRESS '�
Z \9 JA V� L
PHONE 0 tV'7:tZ j" 1"T/7� cEMAIL CONTRACTOR'S STATE LIC NUMBER -3 1 J� LICENSE CLASSIFICATION C2,
VALUATION$ Q FT 2000 L SQ FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION 'n CITY OF MENIFEE BUSINESS UCEN5E NUMBER
BUILDING PLANNING ENGIN RING FIRE GREEN W SMIP
INVOICE PAIDAMOUNT O
AMOUNT CASH O CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT O.CASH OCHECK# OCREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department29714 Houn Rd. Menifee, CA92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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