pmt18-04922 City of Menifee Permit No.: PMT18-04922
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Mechanical
MENIFEE MENIFEE Date Issued: 10/09/2018
PERMIT
Site Address: 29554 WINDING BROOK, MENIFEE, CA Parcel Number: 340-250-033
92584 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of HVAC CHANGE OUT COOLING BTU 60,000 HEATING BTU 100,000 5 TONS HEATER IN ATTIC
Work:
Owner Contractor
JOY PERKINS RIZZO HEATING&AIR CONDITIONING
29554 WINDING 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
Fee Description ON Amount IEl
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.
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 ❑1 am exempt from Iicensure under the Contractors State License Law for
Professions Code' and^mmy license is in full force and of art ^�y,�,I.�s-� the following reason:
License Class (Jl-IJ li ens 0. /mil ( c ` By my signature below I acknowledge that,except for my personal residence
Expires 3 NJ _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
.9 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 workers 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 ww%v.leginfo.ca.gov/calaw.htnil.permit is issued.
Policy R Date
have and will maintain worker PROPERTY OWNER OR AUTHORIZED AGENT
s compensation insurance,as required by I
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 workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number aGe:�,L� C;\,ry application and the information I have provided d correct.I agree to comply
Carrier T/� l/�f )', with all applicable city and county ordinances and state laws relating to
Policy � a _E>!p k building construction.I authorize representatives P this city or county to
Poll �I i n r t t above ide tified ra ert dr section ur os s.
(This section need not to be completed is the permit is for one-hundred I Date ��
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT hh��
❑I certify that in the performance of the work for which this permit is issued, �11 �f 7
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE g 0\`� ��I w
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subjec[tot arkersco ensa[ion provisions of5ection 3700 of the Labor
Code; shall f rthwi[h corn I ith those visions. Will the applicant or future building occupant handle hazardous material or a
p i31n on 8 p
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts 5%cified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes 0 ,
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 gui1`lfi as
CONSTRUCTION LENDING AGENCY 0 Yes t�,o
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility he 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) 0 Yes �Jo
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 California Health&Safe Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the s maze a re orting.
checkmark(s)I have placed next to the applicable item a ardou
s)(Section 7031.5 0 0 0
Business and Professions Code).Any city or county that requires a permit to l7 ate .J
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWI 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 FIRM
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 Iicensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis forthe alleged exemption.Any violation of5ection 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
than($500). 4 P P p he owners and property
managers who do the paint-disturbing work themselves or through their
a 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.govllead 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 Contractors State License Law does not apply to an owner of a ❑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. in No EPA Lead-Safe Certified Firm is required for this project because:
01,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 rill out the RRP
('t Acknowledgement.
/10
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
-1fl
DATE: nv vt PERMIT/PLAN CHECK NUMBER "'—Q Z2
PLANNING CASE NUMBER
TYPE: 0 COMMERCIAL XAESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O-M-ECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUAREESS
DESCRIPTION OF WORK
tpmwal
PROJECTADD SS 2�`-I WW 1CII ICA jc—y� ZIP 612
ASSESSOR'S PARM
R LOT TRACT
OWNER NAME
ADDRESS ZG155�'I W 1V-(,A
PHONE ����-�1Se� I 0 EMAIL
APPLICANT NAMZ
\E ' V n
ADDRESS \ �1 1
PHONE CA 1 (O(n 5�3� EMAIL
CONTRACTOR'S NAME OWNER BUILDER. O YES XO
BUSINESS NAM l
ADDRESS (`'�,�� 1
PHONE \ �� � .ol /A�l EMAIL /�
CONTRACTOR'S STATE LIC NUMBER �f",���" 1 L k..�� LICENSE CLASSIFICATION v
VALUATION$ Q) V SOFT 2-�,Q 0C) L SO FT
APPLICANT'S SIGNATURE DATE tug I V
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICETOTAL I GREEN SMIP
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZEDLETTER O YES O NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityof m en ifee.us
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