PMT16-03274 City of Menifee Permit No.: PMT16-03274
29714 HAUN RD. Type: Residential Mechanical
<A_CCELJF;? MENIFEE,CA 92586
MENIFEE Date Issued: 10/0512016
P E R M I T
Site Address: 26075 MURRIETA RD, MENIFEE, CA Parcel Number: 33G-210-023
92585 Construction Cost. $10,000.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT 60,000 BTU COOLING, 100,000 BTU HEATING, HEATER IN ATTIC
Work:
Owner Contractor
TERESA LUNDSTROM RIZZO HEATING&AIR CONDITIONING
26075 MURRIETA RD 29092 RAMBLING BROOKS CT
M ENIFEE, CA 92685 MENIFEE,CA 92585
ApplIcant Phone: 9516720397
ROXANNE EASLEY License Number.,349958
RIZZO HEATING&AIR CONDITIONING
29092 RAMBLING BROOKS CT
MENIFEE,CA 92585
Fee Description 9!Y Amount($)
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 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.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 a I am exempt from licensure under the Contractoes State License Law for
Professions Cod�ncl my license I.s in full force and effect. the following reason;
Ucense Class 2-0 License No- GOi�q By my signature below I acknowledge that,except for my personal residence
Expires Sign,tu' in which I 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
n 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 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.Ieginfo.ca.goy1caIaw.htmI.
this permit is Issued.
Policy# PROPERTY OWNER OR AUTHORIZED AGENT Date
Mhave and will maintain worker's compensation insurance,as required by
�eWion 3700 of the Labor Code,for the performance of the work for which o By my signature below I certify to each of the following:I am the property
this permit Is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property ownees behalf.I have read this
numberare: 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 A,\(V4AM-J b qQstruction-I_ thorize representatives of this city or county to
abog tiff
Policy W\M�l Mn Expires er the :u property for inspection purposes.
(This section need not to be completed Is the permit is for one-hundred 47 Date
dollars($100)or less PROPERTf OWNER OR AUTHOhWED)AGENT
Vicertify that in the performance of the work f6r which this permit is issued,
I sfiall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# 00
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
s.bJj ctt th ker's compensation provisions of Section 3700 of the Labor
giil,ef
Co h it mply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Date 10 mixture containing a hazardous material equal to or greater that the
Applicant 5EEER� E I.W amounts specified on the Hazardous Materials Information Guide?
MLARNING:FAILURE TO SECURE Wk�NER'S COMPENSATION COVERAGE 15 Dyes *
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the Intended use of the building by the applicant or futu re building
AN D CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO TH E COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQM D)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguld Ii
Nnes
CONSTRUCTION LENDING AGENCY Yes 0
1 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?
0
(Section 3097 Civil Code) a Yes X
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the CalffomV a�ca �%Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardoW ma
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 591:�s a No 1-5,
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 OWNER ORMLIVI—ORMED E
issuance,also requires the applicant for the permit to file a signed statement FIRM
that he or she is licensed pursuant to the provisions of the Contractoes State EPA RENOVATION.REPAIR AND PAINTI I
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 Rcensure receiving compensation for most work that disturbs paint in a pre-1978
a nd the basis for the alleged exem ption.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 1,as owner of the propeft or my employee with wages as their sole employees.For mom information about EPA's Renovation Program visit:
compensation,will do I )all of or I )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 1-800-424-LEAD(5323).
Code,The Contractoes State License Law does not apply to an owner of a u 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 yea r 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. ci No EPA Lead-Safe Certified Firm Is required for this project because:
o 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Cantractoes 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 APPLICATION
Menifee
DATE ko"5 IIIIU PERMIT/PLAN CHECK NU
TYPE: OCOMMERCIAL 49IDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL CpkECHANICAL
ONEW OPLUMBING 0 RE-ROOF-N UMBER OF SQUARES—
DESCRIPTION OF WORK At)8G C*VWEI C�,e
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER 0%) LOT TRACT
OWNE
ADDRESS "lum V�A�
PHONE A �A\D EMAIL
APPLICANT NAM Pf)y
c+ _j
ADDRESS 0:::4
PHONE 9Q�VMS2M EMAIL
CONTRACTOR'S NAME. b)j fiC� OWNER BUILDER? 0 YES 94
BUSINESS NAME
ADDRESS RMIr_
PHON EMAIL
CONTI nAlrl�R'S STATE LIC NUMBER
0 C�—;� LICENSE CLASSIFICATION
VALLIATION $ S Lj LSQFT
APPLICANT'S SIGNATURE E
DEPARTMENT DISTRIBUTION % C'T'O'MENIFEE BUSINESS LICENSE NUMBER
W&JRING FIRE
BUILDING PLANNING GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT 1 1 1 —CASH —CHECK4 OCRE61TCARD VISA/MC
PLAN CHECK FEES I PAID AMOUNT I 1 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 No DLNUMBER NOTARIZEDLE17ER 0 YES 0 NO
City of Menifee Building& Safety Department 29714 HOUn Rd. Menifee, CA 92586 951-672-6777
www.cjtyofmerifee.us inspection Request Line 951-24(5-6213
n m a r-) v > n
> m E: 0 0 0 0 0 m
(a m m w w w m
= r) 0 m
>
z 0
w >
m m M C,
0
>
on 0
>
MW
>
>
rb
CD
0
3 q
M<
00
m a 0
0
C o :E * v
m o EL m m
0 m xv
0
0
m X
PA
3E 9 6
CL
0
0
6
>
F, z rL 0
m
0��774
7 rn
m m
0
z z
m 3 3
0 0
k 2 2
0 0
3 3
M > IA 1
(D CD
>
3 3
0 (D
0
0 rD
m
L. 10
- 2 - R . - >
0 0
xm
27
3 2
- 2 <
0 0 3 o
2. a
m
T ET
0 3 0
> D
n
r 73
5
0 0
> >
3 0
o 2, o 2.
0
FD
0
FL
,rn
m Z
0
61 0
F, m
m
> qmqm. z
-A 9 " -a
m w
m
m 'o
m
F, m
m
m m eb w
z m e m
m
Er m
w ra, i., =r
CP Iz 0
z <
R a: 0 ur
2
0 m
o =j rms
g z:2
3 PO
Ra
m
m A
w 0 01
m M. OR m
0 0 lu
L. CP
M- 22
n
Q r) m
0- 0 FF A' 3 -0 > CL m
0
n 0 m
Fi,
3 m m o 2 o
0 R 0. M-
m
M-
9L 3
0
0 m
S
WM 1. � a
7q
w" C
0
=M 0
Ln
0 0 & E 2� p E
m 0
61 0 m m m
in
CD
m
< cn
M rx 0 0
Al 5, 5 3
5
R
00 3
co
42
M3
0 0
0
n w
Ei
2L m m
;� 0 w
0
m
M m