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PMT14-01914 I i City of Menifee Permit No.: PMT14-01914 29714 HAUN RD. MENIFEE, CA 92586 Type: Residential Electrical MENIFEE Date Issued: 07/23/2014 1 PERMIT Site Address: 29930 MOONDANCE WAY, MENIFEE, CA Parcel Number: 338-112-009 92586 Construction Cost: $225.00 '.. Existing Use: Proposed Use: Description of MAIN PANEL UPGRADE 225 AMP Work: Owner Contractor BRIAN&SHARON BOOTS KILLION ENERGY INC - 29930 MOONDANCE WAY 15261 CONNECTOR LANE MENIFEE, CA 92586 HUNTINGTON BEACH, CA 92649 Applicant Phone: 7143738544 DALLAS FERGUSON License Number: 971660 KILLION ENERGY INC 15261 CONNECTOR LANE HUNTINGTON BEACH, CA 92649 Fee Description OQt+ Amount Building Permit Issuance 1 27.00 G EENTFFEE 11 1 1N,0 $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 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 Class u�0 6ly v License No.q>/&66 who builds or improves thereon, and who contracts for the projects with a Expires� 6'/f Signature 6 N licensed contractor(s)pursuant to the Contractors State License Law). L l WORKERS'COMPENSATION DECLARATION ❑ 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 ij 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 Vcompensation insurance, as required Business and Professions Code,is available upon request when this application is section 3700 of the Labor Cade, for the performance of the work for which this have and will maintain workers' submitted or at the following Web site:htto'//www leainfo ca gov/calaw html. s permit is issued.My workers'compensation insurance carrier and policy number are: AlProperty Owner or Authorized Agent Date Carrier A C)rd Expires�` ��/` Po11cy Guf and 6�y #� /Z ❑ By my Signature below, I certify to each of the following: am the property Name of Agent�uhhL Phone# owner or authorized to act on the property owner's behalf. I have read this t be completed if the permit is for application and the information I have provided is correct. I agree to comply (This section need no one-hundred dollars be 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- 0 1 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 _a workers'compensation laws of California, and agree that if I should become ?_,�¢: F�q' l subject to the workers'compensation provisions of Section 3700 of the Labor property Owner o uthorized Agent Date Code,I shall forthwith comply with those provisions. _� �,//_5 City Business License# Date;� Applicant;{ /l 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, OYES 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 ONO 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 &C^ uG DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION C.Y Y FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address ��b� Co L d d"- ❑NO 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 for the reason(s)indicated below by the checkmark(s)I have placed OYES WILLTHE 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 I HAVE READ THE HAZARDOUS MATERIAL provisions of the Contractor's State License Law (Chapter 9 (commencing with INFORMATION GUIDE AND THE SCAQMD PERMITTING Section 7000)of Division 3 of the Business and Professions Code)or that he or OYES 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, SECTI MOT 25505RIAL�tE5533 GD 25534 CONCERNING HAZARDO❑ I, POWt 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; X The Contractor's State License Law does not apply to an owner of a property 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 MENIIFEE PLCK No: P nnit No: City of Menifee 29714 Haun Road Building a Safety Dept. Date: Date: I L\ Menifee, CA 92586 Phone: (951)672-6777 JUL 2 3 2014 Amount Amount. 1 c� Fax:(951)679-3843 Ck#: Ck#: Received Building Combination Permit To Be Completed By Applicant Legal Description: Planning Case: F: Property Address:1 lv Assessor's Parcel Number. Project/Tenant Name: Unit#: Floor#: ��H �qd'O vt OlJ�ri Name: Phone Nolt% )al. Fax No. r,�l ti lyd� �s Owner y Address:-��(J A4,9oI /c,1(.E W y 1 Unit Number Zip Code Email Address: / Name: t—, /� /U A Phon 3y� �r� Fax No. Applicant Addressl (' h �4N Unit Number Zip Code C L Email Address: Name: Phone No. Fax No. 6G Sv lu 5/ a Iv Contractor Address:`S�� b/ Cr7�Ih1°C d Gd Cl ty 11 State Zl Code t'A h A d G!n / 6 ontractor9 y e e�ysiness License o. Contractor's City State of California License No. Classification' CJ b G/ 6116 Number of Squares: Square Footage - .I Description of Work I C4 JJ CONIf / uC 5 Cost of Work: Applicant's Signatureal a:U )V1 .7 iy 7. f5 T . .". Indicate As R-Received or N/A-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 ❑ Gen Tech/Soils Report(on cd only) ❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8'/,x 11) ❑ Structural Calculations ❑ Foundation Plan ❑ 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 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: It Stories: Will the Building Have a Basement? Bldg.Code OccupancyG Y of N Group p ndcate Ii Indicate Indicate all Geo-tech.Haz.Zone At Project Sprinklered YES or NO that apply: Coastal Zone Completion: Construction Type(sy 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. I Planning Comm. Zoning Administrator Fee Exempt City Project I Elec.Vehicle Chargerl Landmark Seismic Retrofit Special Case:Bldg_ Offica)Approval Expedite Project(s): Child Care City Project Green Building Landmark I Affordable Housing For Staff Use Only Building/Safely Pemhl Specialist I City Planning Civil Engineering I h,VWM-A(ul 1 Transportatiol 1 Rant Control THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY