PMT16-03195 City of Menifee Permit No. PMT16-03195
29714 HAUN RD. Type: Residential Mechanical
<XCCIELA-> MENIFEE,CA 92586
MENIFEE Date Issued: 09/27/2016
P E R M I T
Site Address: 27898 LAKES LANDING DR, MENIFEE, Parcel Number: 333-361-016
CA 92585 Construction Cost: $7,500.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT 60,000 BTU A(C, 100,000 BTU FURNACE
Work:
Owner Contractor
CHRIS WENTZ RIZZO HEATING&AIR CONDITIONING
27898 LAKES LANDING DRIVE 29092 RAMBLING BROOKS CT
MENIFEE, CA 92585 MENIFEE, CA 92585
Applicant Phone:9516720397
ROXANNE EASLEY License Number. 349958
RIZZO HEATING&AIR CONDITIONING
29092 RAMBLING BROOKS CT
MENIFEE, CA 92585
Fee Description QtV Amount
Forced-Air or Gravilty-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 correcrion of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in viciation 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_Pe"it TempIate,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 perjury that 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 ci 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 following reason;
License Class_Lz:a�No. By my signature below I acknowledge that,except for my personal residence
Expires Signatur In which I must have resided for at least one year prior to completion of
U improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION
7, __ have built as an owner-builder if it has not been constructed in its entirety by
*4!Eereby affirm under Pena Ity of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
ere rm
e and willifimaintain a certificate of consent of self-insure for worker's 7044 of the Business a nd Professions Cad e,is available upon req uest when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following welisite;
by Section 3700 of the Labor Code,for the performance of work for which
this perm vvww.Ieginfo.ca.goyJcaIavv.html.
Policy# Date
have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which Y nrysignature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy /Qwner or authorized to act on the property owner's behalf.I have read this
number are: application and the information I have provided Is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
nt r the a ve identified property for inspection purposes.
Policy# t!�HR�ftEpires
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less PR61ERTY OWNER OkAUWORIZED AGENT
A$4ertify that in the performance of the work for which this permit is issued, _11C
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# Sb
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
sub 5 compensation provisions of Section 3700 of the Labor
t s
t� ly with those provisions.
j:c� Will the applicant or future building occupant handle hazardous material or a
Cod shallfo`thwlt�Kh� 1P
Applica Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE RIKEWS COMPENSATION COVERAGE IS a Yes Mo
UNLAWFUL,AN D 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 �y Ma nagement District(SCAQM D)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST�AND ATTORNEYS FEES forguldelines
4
CONSTRUCTION LENDING AGENCY ci Yes 1ro
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) 0yes WPO
OWNER BUILDER DECLARATIONS I have read the Haza rdous Material Information Guide and the SCACIM D
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I a in exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the It rdous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 _1ZyZ-`s allo
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to Its PROPERTY OWN ER OR AUTHORIZED AGENT
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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING fRRP)
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 com pensation for most work that dlstu rbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childca re facility to be RAP-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
ci 1,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.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions I-BOD-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a n 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:
a 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If you r project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
-.1"'Menifee
DATE (21 '2_1 'Ii�O PERMIT/PLAN CHECK NUMBER
TYPE: �� COMMERCIAL X�RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME - POOL/SPA 0 SIGN
SUBTYPE: 0 ADDITION ALTERATION r'DEMOLITION ELECTRICAL >1 MECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES-
DESCRIPTION OF WORK _�VY�L QaQM a �t ewwo ��M A w)I M)
WfilwOu �m - YZI-Win OC &
PROJECTAIDDRESS va
\j
ASSESSOR'S PARCEL IN UMBER LOT TRACT
VU-7-
OWNER NAME rklhs WeATI -C City of Menifee
ADDRESS STOS WUS kCAVVA_ 1ryq Building & Safety Dept.
PHONE EMAIL SEP 2 7 2016
APPLICANT N���
ADDR
PHONE OS\ Uorl EMAIL
CONTRACTOR'S NAME Q,\Z2,0 OWNERBUILDER? OYES>ONO
BUSINESS NAME'�_,aaD "VA4AE
ADDRESS
1�j
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION 6ZO
VALUATION $-I)Im LSQFT
APPLICANT'S SIGNATURE DATE �o
DEPARTMENT DISTRIBUTION SMIP CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE PAID AMOUNT
AMOUNT � I I -)CASH --CHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT
CASH --CHECK#
CREDIT CARD VISA/M
OWNER BUILDER VERIFIED C,YES NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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