PMT14-01013 City of Menifee Permit No.: PMT14-01013
29714 HAUN RD.
L MENIFEE, CA 92586 Type: Residential Electrical
MENIFEE Date Issued: 0 510 612 01 4
PERMIT
Site Address: 24618 CONEJO DR, MENIFEE, CA 92587 Parcel Number: 341-170-019
Construction Cost: $1,800.00
Existing Use: Proposed Use:
Description of 200 AMP SERVICE UPGRADE FOR SOLAR PERMIT PMT14-00579
Work:
Owner Contractor
CHRISTOPHER MUELLER CAMPBELL ELECTRIC SOLAR
24618 CONEJO DR P 0 BOX 8358
MENIFEE, CA 92587 MORENO VALLEY, CA 92552
Applicant Phone: 9517560112
BRANDON CAMPBELL License Number: 924323
CAMPBELL ELECTRIC SOLAR
P 0 BOX 8358
MORENO VALLEY, CA 92552
Fee Description
Oft Amount
Receptacle XS t h',utle�&F xtu�e 1
+u,L.n:.tu�i..mCr.us�4'Sw.a.§�fskv. `.s%:^isu&:� +S ..�`G':... ^.ms"�.Ls..SEnac'u^Y>X�,
Building Permit Issuance 1 27.00
$144.00
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_Bidg_Permit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Code and nay license is in full orce and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class�License No. 3Z who builds or improves thereon, and who contracts for the projects with a
Expires Signature,, licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS' OMPENSATION DECLARATION
❑ I am exempt from licensure under the Contractors'State License Law for the
❑ 1 hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in
compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have
permit is issued. built as an owner-building if it has not been constructed in its entirety by licensed
Policy# contractors. I understand that a copy of the applicable law, Section 7044 of the
❑ 1 have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:Into'llwww lecinfo ca cov/calaw html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Property Owner or Authorized Agent Date
Carrier
Expires Policy#
❑ By my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
construction.I authorize representatives of this city or county to enter the above-
1 certify that in the performance of the work for which this permit is issued,I identified open r er'(Fe#spection purposes.
shall not employ any persons in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers'compensation provisions 'on 3700 of th r roper y Owner or Authorized Agent �( D e
Code,I shall forth ith comply with those pro O l I O�
City Business License#
Date; S Applicant;
WARN NG. FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, ❑YE CCUPANT HANDLE A HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending
INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS
I hereby affirm under penally of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed AYES ILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s)(Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, O SCHOOL?
or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the I HAVE READ THE HAZARDOUS MATERIAL
provisions of the Contractor's State License Law (Chapter 9 (commencing with
Section 7000)of Division 3 of the Business and Professions Code)or that he or DYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any /�H ECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to TnTiCf UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECOUS ION 25505ATERIALf}E5533,AND 25534 CONCERNING
HAZAR❑ I, as owner of the property, or my employees with wages as their sole
compensation,will do( )all of or( )porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
i
CITY OF MENIFEE PLCK No:
29714 Haun Road
Dale: Date (0 /
Menifee, CA 92586
Phone: (951)672-6777 Amount Amoun:LN
fro
Fax:(951)679-3843
Ck w:
vt5A
Building Combination Permit CAI
To Be Completed By Applicant
Legal Description: O Planning Case:
R:
Property Ad dress: Assessor's Parcel Number.
7e: vne 3w 1-70- of cl
Projecl/Tenanl Name: Unit k:
t� t1P (e/ Floor K:
Name: S� L,. J o `"'II pe e Z 2 Fax No. _
qq
Property gddress: •,
Owner �q Con e Unit Number Zip Code
Email Address:
Name/10. ��1� Na.
Phan 1 J Fax No.
Applicant Address: nit Number�b
Z S-7(S JGr I $' Zip ode
Email Address: .-
Name: II II
bPU (pc4 fir (� 9 Phone o. I Fax No,
ConUactpr Add :, ,IS State Zi Code
J ✓e,_ S (_or�c l t�dc CP S ?i9
onva ccor's�{[ sySsLyen so No. Coht�c�'s ityS tate of California License No.
fit// r,JV J ` Classifican
Num9er a(Squares.
Square Footage
Description of Work: LC Cost of Work:
L L� i'
Applicant's Signature
PO ' S-7 Date:
` _'7o Be Completed By City Staff only = % - -
Indlcate As R Received or WA-Not Applicable
S Completes eels of rutty dimensioned•drawn to sale piers which induce 1 set of don:mer s wtiicn induda
❑ Title Sheet ❑ Eleva'iors ❑ Electrical Plan ❑ Can T=_ch/Soils Report(on cd only)
❑ Piotl Site Plan ❑ Roof Plan Tide 24❑ Mechanical Plan ❑ Energy(on B ;4 x t 1)
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Structural Calculations
❑ Single Line diagram for alien services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Sharing Plan ❑ Sound Report-Residential
Class Code' Indicate New Construction Alteration' Addition' Meansndatheds
Work Type.- Repair' Retrofit' Rasisicn to Existing Permit' RequirerP YES NO
Proposed Building Use(5): Existing Building Use(s):
k Buildings: Un,ts: k Stories: y^AII the Buitding Have a 8asement7
Y of i•I
Bid]. Cody Occupancy Group Inoicate Indicate if Indicate all Geo-tech. Flat.Zore
At Pro]ect Sprinklcred YES or NO
Completion: Construction that apply Coastal Zone
I Weis): C OfO Y[5 or NO Noise Zone
Renuired7 Lisle)on His!oric Resources Ir.:-,.•:•.--
CITY PLANNIPIG STAFF ONLY
APPROVALS: Costal Cornmiss Arch.Review Board Landrnar:<Comm. Planning Comet 7cr.r- :
"nr
Fee Exempt. City Project Elec_Vehicle Charger I_ancirna6 Seismic Rr roF•
Exped,ie Prolect15) Child Care City Project Green Building Landmark
For Staff Use Only ---------
t
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY