PMT16-04258 City of Menifee Permit No. PMT16-04258
29714 HAUN RD. Type: Residential Mechanical
<ACCEI-ilt> MENIFEE, CA 92586
MENIFEE Date Issued: 12120/2016
P E R M I T
Site Address: 28862 CAPANO BAY CT, MENIFEE,CA Parcel Number; 388-060-004
92584 Construction Cost: $8,500.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT,60,000 BTU FURNACE,60,000 BTU A/C
Work:
Owner Contractor
STEVE HOAK RIZZO HEATING&AIR CONDITIONING
28862 CAPANO BAY COURT 29092 RAMBLING BROOKS CT
MENIFEE, CA 92584 MENIFEE,CA 92585
Applicant Phone: 9516720397
ROXANNE EASLEY License Number: 349958
RIZZO HEATING&AIR CONDITIONING
29092 RAMBLING BROOKS CT
MENIFEE, CA 92585
Fee Description Pty Amount($
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 pennft 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.
AkBIdg_Pemift—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 Cr I am exempt from licensure under the Contractor's State Cicense Law for
Professions Ca icense is in full force and effect. the followhig reason:
ense
u1cense-/I SZ By mysignature below I acknowledgethat except for my personal residence
Expires Vpr Signature inwhich I musthave resided for at least one year prior to completion of
improvements covered by this permit.I cannot legallysell a structure that I
WORKEWS COMPENSATION DECLARATION have built as an owner-builder If it has not been constructed in its entirety by
cs 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
com pensafilon,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website:
by Section 3700 of the La bar Code,for the performance of work for which vvvvvv.IegInfo.ca.gcy/caIaw.html.
this permit Is Issued.
Policy# Date
'XI have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
geEfloss 3700 of the Labor Code,for the performance of the work for which 4 V 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 an the property OWIIEFS behalf.I have read this
number are: applicatlian and the Information I have provided is correct I agree to comply
with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this City or county to
Policy# VV I -119VI 2MIT d If d f '
Expires ,--essarrdre-alinve I enti te property or inspection purposes.
Dateol 2,1-1(9_
N
N
T
(doliam($100)or less -��PRORTYOW�NEROR U �RIZED AGE T
This section need not to be completed Is the permit is for one-hundred
Aartily that in the performance of the work for which this permit is Issued,
1111notemol any persons in any manner so as to become subject to the CITY BUSINESS LICENSE If ()D ri5D
worker's compensation laws of California,and agree that If I should become HAZARDOUS MATERIAL DECLARATION
subject tbizAvarker'sxompensad In provisions of Section 3700 of the Labor
Code,I I rovisions. Will the applicant or future building occupant handle hazardous material or a
Applicant. Dat,,1- I mixture containing a hazardous material equal to orgreater thatthe
amounts ecifted on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE"ER'S COMPENSATION COVERAGE IS cs Yes 9NO
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or furtu re building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,(300),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 forguid lin
CONSTRUCTION LENDING AGENCY 0 Yes
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 far the performance of the work which this permit is issued outer Is dary of a school?
"Unc
(Section 3097 Civil Code) u Yes 1-Ao
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
pe C"Ist;'llanderstand my requirements under the State of
ec
r
I hereby affirm under penalty of perjury that I am exempt from the CaRT'nt,Heallil Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazVdaul_Tater'sal orting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Date
Business and Professions Code).Any city,or county that requires a permit to
construct,a Iter,improve,demolish or repair any structure,prior to its PROPERTY 6WNER ORAU IZED 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(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 licensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the a Ileged exemption.Any violation of Section 7031.5 by residence or childcare facillitV to be RRP-certified firms and comply With
a n Applicant for a permit subjects the applicant to a civil pena Ity of not mare 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 sale 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 1-800424-LFAD(5323).
Code,The ContractoesState License Law does not applyto an owner of a a An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employeee 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 Noz
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. a No EPA Lead-Safe Certified Firm is required forthis project lodcause:
D 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 your project does not comply with EPA RRP rule please rill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
"Menifee
DATE �2 '0'lq PERMIT/PLAN CHECK NUMBERPMO - C�afv?.
TYPE: OCOMMERCIAL �kESIDENTIAL � MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOUTION OELECTRICAL�<MECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK %)AC,, 00606 CUP Vanq V-�TU �00,0-JD N3,*9 M4
kx),= w
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNERNAME 0�-Qvp, City af 11denifoo
ADDRESS Building & Safety Dept.
PHONE EMAIL DEC 2 0 2016
APPLICANTNAME
ADDRESS 7(AtDo Cot
PHONE (�V
)kUDLA�01--5+ EMAIL
CONTRACTOR'S NAME OWNERBUILDEL? 0YESJkNO
BUSINESS NAME
ADDRESS '2qOoVl WAW)&rVA )bW7W-
ki EMAIL
PHONE 0115\ �nl ()L
CONTRACTOWS STATE LIC NUMBER ;�LkqqSt LICENSE CLASSIFICATION
VALUATION$ V-MIJ-0 SO FT L SO FT
APPLICANT'S SIGNATURE DATE
rci WS-TA---F-F"-U,-S-E,-O"N-,L,Y
ULPARIMENI UlhIRIBUIUN CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE PAID AMOUNT
AMOUNT %0 � I zQ4. I t) CASH 0 CHECK It OCREDITCARD VISA/MC
PLAN CHECK FEES I PAIDAMOUNT I I C)CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 No DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Metiffee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofn7enifee.os inspection Request Line 9SI-246-6213
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