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PMT14-01113 City of Menifee Permit No.: PMT14-01113 29714 HAUN RD. tCCIE./4. MENIFEE, CA 92586 Type: Residential Electrical MENIFEE Date Issued: 0 5/1 512 01 4 PERMIT Site Address: 25671 ROYLENE DR, MENIFEE, CA Parcel Number: 335-402-011 92586 Construction Cost: $1,645.00 Existing Use: Proposed Use: Description of MAIN PANEL UPGRADE 100 AMP TO 200 AMP Work: Owner Contractors DAVID GRAY PROVOLT ENERGY INC 25671 ROYLENE DRIVE 29354 HUNCO WAY STE B MENIFEE, CA 92586 LAKE ELSINORE, CA 92530 Applicant Phone: 9512459999 PROVOLT ENERGY INC License Number: 963600 29354 HUNCO WAY STE B LAKE ELSINORE, CA 92530 Fee Description (3lY Amount z s g 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_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 c tractors to construct the project(Section 7044, Business and Professions Professions Code and my license is in full force and�ect. Code:The Contractor's License Law does not apply to an owner of a property License Class CIO License No who builds or improves thereon, and who contracts for the projects with a Expires/ 3/"/ ) Signature licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARATION ❑ I 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 have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is ction 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto'Uwww leoinfo ca oovlcalaw html. permit is issued.My workers'compensation insurance carrier and policy number are: �^ ��'J Property Owner or Authorized Agent Date Carrier J Expires Policy# /q'�7o 7 By my Signature below, I certify to each of the following: I am the property Name of Agent WO C�d�ocv✓,.� Phone# �y" �' ) "7 o ner cr 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-Kundred 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- certify that in the performance of the work for which this permit is issued, I identified property for the inspection purposes. Is ill not employ any persons in any manner so as to become subject to the _ p workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of ection 3700 of the Labor Property Owner or ed Agent Date Code,I shall forthwith comply with those provisions City Business License# Date; Applicant; WARNING: FAILURE TO SECU E 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, DYES 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 O EQUAL TO OR GREATER THAN THE AMOUNTS CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? I hereby affirm that under the penalty of perjury there is a construction lending 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 PRINT NAME: I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law forthe reasons)indicated below by the checkmark(s)I have placed DYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY next to the applicable ilem(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 CHOOL? 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 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 ' ES 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($500).) CODE SE S ION 25ALSf';E5533 AND 25534 CONCERNING HAZA�DO❑ I, as owner of the property, or my employees with wages as their sole compensation, will do ( )all of or( ) porting of the work, and the structure is PROPERTY OWNE OR AUTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the Improvements are not intended or offered for sale. If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). CITY OF 1V"l liiNJtll'llilu PLCK No: Permit No: 29714 Haun Road City of Menitee Building & Safety Dept;Dal.: rAmount: :Menifee, CA 92586 S 115Phone: (951)672-6777 MAY 15 P01q unt: Fax:(951)679-3843 Ck#: Ck#: Building Combination Per�mtOPDiVed To Be Completed By Applicant Legal Description: PlanningCase: F: L: Rt: R: Property Address: Assessor's Parcel Number. Z567/ /To P.JL° '�rU - 11 Projectlrenant Name: Z—q� : Floor if: Name: /Z,4` P Fax No. Property Address:Owner z 5-&7 Ao N e, - /t/ ueUn Zip Co Email Address: Name: S �tJ tit l ACE PiTor No. (7 0 Fax No. Applicant Address: Unit Number rp, Zip Code Email Address: FAddress, �' Phon Fax No. .�C. -zyS"• y�i99 Contractor zy N(Q , 'G C;h,�/G C G� Stems Zip Code ctor sCity Business License No. Contractor's Cily t e f lifomnn icense No./ (J� z J Classification: .O Number or Squares: Square Footage. Description of Work: . 4,N /u Cost of Work:$ OO.q.ar Z 0 0.l-�.,�. � Applicant's Signature Date: -To'8 - mpleted By:City Staff Only - - - -- -- - Indicate As R-Received or N/A-NotApplicable 5 Completes sets of fully dimensioned,drawn to sale plans which include: 1 set of documents which include ❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Gen Tech/Soils Report(on cd only) ❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 '/,x 11) ❑ Foundation Plan ElCross Section ❑ Plumbing Plan ❑ Structural Calculations ❑ Single Line diagram for elec.services over 400 AMP ❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ 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: Flndimte Stories: Will the Building Have a Basement? Y of N Bldg. Code Occupancy Group if At Project IndicateYES or NO Indicate all Geo-tech.Haz.Zane I Construction nklered that apply: Coastal Zone Completion: Type(s): C Oro 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 EAdmmistratoEr Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit special Bldg.Official Aal Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing For Staff Use Only Building/Safely Permit Specialist I City Planning Ciml Engineering EPWM-Atlmin Transporlalion Mgml Renl Control THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY