PMT14-01050 City of Menifee Permit No.: PMT14-01050
_ 29714 HAUN RD.
'9I6CEL-A>k. MENIFEE, CA 92586 Type: Residential Electrical _
e""""n"''Wt., MENIFEE Date Issued: 06/08/2014
PERMIT
Site Address: 28050 WINTHORP CT, MENIFEE, CA Parcel Number: 339-401-018 -
92586 Construction Cost: $3,450.00
Existing Use: Proposed Use:
Description of UPGRADE FROM 125 AMP TO 200 AMP MAIN PANEL
Work:
Owner Contractor
RANDALL JOHNS ROBERT M CANVIN
28050 WINTHORP COURT 941 W BISHOP STREET
MENIFEE, CA 92586 SANTA ANA, CA 92703
Applicant Phone: 7145474924
ROBERT M CANVIN License Number: 385439
941 W BISHOP STREET
SANTA ANA, CA 92703
Fee Description (O,yt Amount
r mvirr„ m+'+v^sm3*^ra+.-ram w-.-r.-,�,.r^^� s*
serviceswif hl?oards,COntrol Centers&Panels� �"r,�;, 1 18 p(f
«w�.aasx .....
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_Bldg_Permit_Templatesirt Page 1 of 1
City Of Menifee
I, 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 Co jand y license is in Tull f rce and e ct. Code:The Contractor's License Law does not apply to an owner of a property
License Class`^�(� License N who builds or improves thereon, and who contracts for the projects with a
Expire ture licensed contractor(s)pursuant to the Contractors State License Law).
ve�slgna
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from licensure under the Contractors'Slate 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 to e-f 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 Lam e, 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:hftp,//www.IeQinfo.m.gov/calaw.html.
permit is issued.My workers'compensation insurance carder and policy number are:
Carrier Property Owner or Authorized Agent Date
Expires Policy#
❑ By my Signature below, I certify to each of the following: I am the properly
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-
El I certify that in the performance of the work for which this permit is issued, I identified property for the inspection 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 of Sectio 00 of the Labor Property Owner or Authorized Agent Date
Code,I shall forthwith comply with those provision
( CiN Business License#
Dated l Applicant;
WARNING: 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, AYES OCCUPANT 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 El 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 ❑NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS GUIDE LINES
I hereby affirm under penalty 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 DYES WILL 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, ❑NO 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
provisions of the Contractor's State License Law(Chapter 9(commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of theSusiness 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 CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION
E 3TI ON 25505RIAL tf POR3IN6 D 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole
compensation,will do( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF M]ENIFElE
PLCK No: Permit No:
(/ 29714 Haun Road City &S fety Dept. Date: Date: ��
�e r}4�j;rNh Menifee, CA92586Building �s hU
Phone: (951)672-6777 TTpunt Amount:
Fax: 951 679-3843 MAY
( ) Ck#: Ck#:
Building Combination P P'\ ed
To Be Completed By Applicant
Legal Description; Planning Case: F: L: Rt: R:
Property Address: r C>,� h -64 Assessor's Parcel ber.
-QVQ �� i� IN 1f\0 �j
ProjecUTenant me: Sv,J Unit#: Floor#:
PE N l� (.� L-}.�}
Name: Phone o. Fax No.
N. ! o rQS / lJ�/Z�
Property gddras
Owner �'p�-p (,� i�/ -F(,�r ��-- Unit Number Zip Codega
Email Address:
Na Phone No. Fax No.
Applicant Addrel Unit Number Zip Code
GI l vJ- ISt�. S�
Email Address: !
Name: l r Phone No. Fax No.
) (�i 7q(
Contractor Address: city State z Cade
,tl G�J, s� 5' � `Y�-7O
ontractor s ulty ustness Eicefisna No. Cont r tor's Cityate St f Califomia License No. Classification:
G
Number of Squares:
Square Footage {,.
Description of Work: V r`l Cost of Work:$ r•
e
Applicant's Signature
Date:
XI X To.Be ompleted By CltyiStaff Only -
Indicate As R-Received or N/A-Not Applicable
5 Completes sets of fully dimensioned,drawn to sale plans which include: t set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Goo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8%x 71)
❑ Structural Calculations
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan 8 Details ❑ Shoring Plan I ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration* Addition" Means/Methods
Work Type: Repair' - Retrofit* Revision to Existing Permit' Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have a Basement?
Y of N
Bldg. Code Occupancy Group Indicate Indicate if YES or NO Indicate all Geo-tech.Haz.Zone
At Project Construction Spdnklered that apply: Coastal Zone
Completion:
Type(s): C Of O YES or NO Noise Zone
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec-Vehicle Charger Landmark Seismic Retrofit Special Case:61tlg.
Of d.1 Approval
Expedite Project(s): Child Care City Project Green Building Landmarki I Affordable Housing
For Staff Use Only
Building/Safety I Permit Specialist City Planning I Civil Engineering I EPWM-Admin I I ranspodalion Mgmt. I Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY