PMT18-04923 City of Menifee Permit No.: PMT18-04923
�+ 29714 HAUN RD.
y/ & MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 1 010 91201 8
PERMIT
Site Address: 28695 SHADY BROOK, MENIFEE,CA Parcel Number: 340-250-034
92584 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT 5 TONS COOLING BTU 60,000 HEATING BTU 100,000 HEATER IN ATTIC
Work:
Owner Contractor
ROGER HAYWARD RIZZO HEATING&AIR CONDITIONING
28695 SHADY BROOK 32823 TIZNOW
MENIFEE, CA 92584 MENIFEE,CA 92584
Applicant Phone:9516720397
ROXANNE EASLEY License Number:349958
RIZZO HEATING&AIR CONDITIONING
32823 TIZNOW
MENIFEE,CA 92584
Phone: 9516720397
Fee Description 21 t Amount l8l
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.
.. r__'_._—. 0---4 of�
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 ❑I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and eflfart1.1 ^,,-,.0 C� the following reason:
License Class l/� 1i ens o. ��jj`TL�/lJ By my signature below I acknowledge that,except for my personal residence
Expires_Signature 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
*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 �vs�rv,le�info.ca.eov/calaw.html.
this permit is issued.
Policy 4 Date
44 have and will maintain workers compensation Insurance, OWNER OR AUTHORIZED AGENTnce,as required by �
section 3700 of the Labor Code,for the performance of the work for which 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 owners behalf.I have read this
number t;G;, t��/�1 `rn application and the information I have provided is correct.I agree to comply
Carrier 1 t�'�r `� C�` ' ' _ with all applicable city and county ordinances and state laws relating to
�y 11 II building construction.I authorize representatives of this city or county to
Policy R1� �rl l r "� F.+lprre _an r t t above ide tified property,f�pection purpos 7�
(This section need not to be completed is the permit is for one-hundred Date nI I✓
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
O I certify that in the performance of the work for which this permit is issued, r v1�\��1 1
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE 9 ..�JJJ✓✓✓
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to t orkers5o ensation provisions of Section 3700 of the Labor
Code, shallf rthwith comply i[h those ovisions. Will the applicant or future building occupant handle hazardous material ora
�I(31n mixture containing a hazardous material equal to or greater that the
Applicant Date amounts sified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes IT
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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guid`elii as
CONSTRUCTION LENDING AGENCY ❑Yes 10
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) o Yes Z�Jo
OWNER BUILDER DECLARATIONS 1 have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
1 hereby affirm under penalty of perjury that 1 am exempt from the
California Health t4 Safe Cade,Section 25505 and 255
Contractors license Law for the reason(s)indicated below by the Cl
m�f e a re orting.
checkmark(s)I have placed next to the applicable item a ardous s)(Section 7031.5 O O o
Business and Professions Code).Any city or county that requires a permit to ate
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OW OR AUTHORIZED A ENT
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 IRRPL
License Law(Chapter 9(commencing with Section 70aD)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.Anyviolation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant far 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 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.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-SOD-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an ownerof a O 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 Finn 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:
o 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 APPLICATION MENIFEE
�l
DATE: ' ` I PERMIT/PLAN CHECK NUMBER l (i
PLANNING CASE NUMBER
TYPE: " COMMERCIAL XRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION G DEMOLITION O ELECTRICAL XIVIECHANICAL
O N\EW, O PLUMBING O RE-ROOF NUMBER F(S�QUUAR`EES� VIM
DESCRIPTION OF WORK v W { 1 �J (�J 1
PROJECT ADDRESS L.l�V� - IV S /'\��x� ZIP
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER N kM7
ADDRESS L� ` 1 (�� '\
V PHONE 24->gS I� EMAIL
APPLICANT NAM (E�� M C S
ADDRESS
PHONE,�QG 1 JG_�� EMAIL e I C
CONTRACTOR'S NAME �� 1 `�TAV/' � OWNER BUILDER? 0 YES
BUSINESS NAME �(V ,
ADDRESS ZvXa vjnm1 Uwk
PHONE /J EMAIL
CONTRACTOR'S STATE LII`yC NUMBER Sqq tq� LICENSE CLASSIFICATION
VALUATION$ kO`OWE SQ FT LSQ FT`1 I
APPLICANT'S SIGNATURE DATE 1O l
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICETOTAL GREEN SMIP
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofinenifee.us
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