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PMT14-01061 City of Menifee Permit No.: PMT14-01061 29714 HAUN RD, Type: Residential Electrical <X6Cr6�i MENIFEE, CA 92586 cw xsat"""" MENIFEE Date Issued: 05/08/2014 - PERMIT Site Address: 28918 CAPANO BAY CT, MENIFEE, CA Parcel Number: 388-060-006 92584 Construction Cost: $1,500.00 Existing Use: Proposed Use: Description of 225 AMP MAIN PANEL UPGRADE Work: Owner Contractor CAROLYNTWYMAN VERENGOINC 28918 CAPANO BAY CIRCLE 20285 S WESTERN AVENUE STE 200 MENIFEE, CA 92584 TORRANCE, CA90501 Applicant Phone: 3108039053 VERENGO INC License Number: 935263 20285 S WESTERN AVENUE STE 200 TORRANCE, CA 90501 Fee Description Oft Amount 1$1 Sen lc s Swftchh cards ontrol Genfers PaF`7(t , w'S+ wc�§ .. e. .,n.3;, - 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 Cade 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_Permil_Templatarpt Page 1 of 1 City Of Menifee LICENSED DECLARATION I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ 1, 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 my license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property License Classyy /29 License No. who builds or improves thereon, and who contracts for the projects with a Expires 3 r - Signature - licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DEC ❑ 1 am exempt from licensure under the Contractors'State License Law for the ❑ I 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 G�- I 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:h>t'//www.IegInfo.ca.gov/caIaw.htmI. permit is issued.My workers'compensation insurance carrier and policy number are: Property Owner or Authorized Agent Carrier 51- Date f4+/�-� ��dJ�i`T�`' /r�" - Expires/!�Y Policy# ZO o 0 0 J(Z vA�-/V- Phone# �'/© -S'6 J"• ��i 1/0 ❑ By my Signature below, I certify to each of the following: I am the property Name of Agent ram_ owner or authorized to act on the property owner's behalf. have read this .y7/✓/0✓✓a application and the information I have provided is correct. I agree to comply (This section need not be completed if the permit is for one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating t 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 �/-'j�''` �-'- S'- �' subject to the workers'compensation provisions of Section 3700 of the Labor P Code,I shall forthwith comply with those provisions. Property Owner ut ri ed Agent Date _ 7 7,,r Applicant; f f�` /y� City Business License# Date; y�/ `�5''�� WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND - -CIVIL-FINES-UP-T-O-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 [I 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 AYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address ❑NO DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR GUIDE LINES OWNER BUILDER DECLARATIONS 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 AYES 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 the Business and Professions Code)or that he or AYES 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 25505 25533,AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL F EPORTIN& compensation, will do ( )ail 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 Stale 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 MEIN IFlEE PLCK No: Permit No: 29714 Haun Road Build ng&f afety Date: Date: Dept "010 Menifee, CA 92586 Phone: (951)672-6777 MAY 0 8 2014 Amount: Amount: Fax:(951)679-3843 Ck#: Ck#: Building Combination Permeceived To Be Completed By Applicant Legal Description: ,too Satraa� Planning Case: F: L: Rt: R: /L(a✓N i Property Address: Assessor's Parcel Number. 2 8 C fF PAN o a.'t y if co Projec enanl Name:C�� r_ Unit#: Floor#: Name: C fi e-a 1_Y�,,j / wy� Phone No. Fax No. Property Owner Address:Z g !� Unit umber Zip Code 9 el ,tea y p Email—Addresszs: Name: Phone No. Fax No. Y ''ti'oI CJ rJ ,9lo Sj Applicant Address: Unit Number Zip Cod `Z e DZ e� l-- I/u C T c Q_'/`� i}✓� (J/L�1-R/�LCs` Psrg�'� 7../TL' `2�G'-7 Email Address: Name: V c&2—, e r� 6 -5,L-F�` Phone No. Fax No. Contractor Address: - ns State ZipCode u 1N c loarz-+4N L- �r 7J / on ractor s CRY Business icense 1,13. Contractor's Cit State of California License No. classificatiorc Number of Squares: o - Square Footage Description of Work: /1`7 /$141 /PA 1v S� J veS r z—In,C Z � � Cost of Work:$/�v Applicant's Signature Date: / To Be Completed By City—Staff Only - - - Indicate As R-Received or NIA-Not Applicable 5 Completes sets of fully dimensioned,drawn to sale plans which include: 1 set of documents which include ❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cd only) ❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on a'%x 11) ❑ Foundation Plan ❑ Structural Calculations ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP ❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential Class Cade: Indicate New Construction Alteration' Addition' Means/Methods Work Type: Repair" Retrofit* Revision to Existing Permit* Reguired7 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 Indicate all Geo-tech.Haz.Zone At Project Spdnklered YES or NO Completion: Construction that apply: Coastal Zone 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:Bldg. OfficialApproval Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing For Staff Use Only Building/Safety Permit Specialist City Planning I Civil Engineering I EPWM-Admin Transponation Mgml I Rem Control THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY