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PMT14-02278 1 { I City of Menifee Permit No.: PMT14-02278 29714 HAUN RD. j CGEL. MENIFEE, CA 92586 Type: Residential Electrical MENIFEE Date Issued: 08/26/2014 it PERMIT Site Address: 29120 PRESTWICK RD, MENIFEE, CA Parcel Number: 338-086-014 92584 Construction Cost: $1,500.00 Existing Use: Proposed Use: Description of EXISTING ELECTRICAL PANEL UPGRADE 200 AMPS Work: Owner Contractor JO STATON SMITH ELECTRICAL CONTRACTORS INC 29120 PRESTWICK RD 8733 N MAGNOLIA AVE 112 MENIFEE, CA 92584 SANTEE, CA 92071 Applicant Phone: 6197589829 GAIL LANGFORD License Number: 871200 SMITH ELECTRICAL CONTRACTORS INC 8733 N MAGNOLIA AVE 112 SANTEE, CA 92071 Fee Description ,Oit Amount f$1 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_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 Cla s ( License a. 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'COMPENSATION DECLA TION ❑ I am exempt from licensors 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. Policy# built as an owner-building if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is action 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htty flwww.leginfo.ca.00vlcal aw html. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier -{ ]c Property Owner or Authorized Agent Date Expires Z / 1! Policy# /rOC `1��I�� ,0'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- 0 1 certify that in the performance of the work for which this permit is issued,I identified property for the inspectiop purposes. ��, shall not employ any persons in any manner so as to become subject to the — /, !' ' 'y workers' compensation laws of California, and agree that if I should become , —6l. L— subject to the workers'compensation provisions of Section 3700 of,(he Labor operty Owner or Autho ed Agent Date- Code, I shall forthwith comply with those provi wins ,,/),, el City Business License# Date;_��"/n(>/t 7 Applicant; f WARNING: FAILURE TO SECUR 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 ENO 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, ,D"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 p-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($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL IfEPORIING. compensation,will do( )all of or( ) porting of the work, and the structure is PROPE5Tf OWNER O UTHORI AGENy not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or Improvement is sold within one year of completion,the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). CITY OF ME1a YY'EE PLCK No: P mi o i -oa L 29714 Haun Road Date: ate: � / Menifee, CA 92586 v".�C, Phone: (951)672-6777 Amount Amount: Fax:(951)679-3843 Ck#: Ck#: Building Combination Permit To Be Completed By Applicant Legal Description: Planning Case: F: L: Rt: R Property Address: Assessor's Parcel Number O O 29120 PRESTWICK RD 92586 Project/Tenant Name: Unit#: Floor#: Name: JO STATON Ph/Vd-c�80-2518 Fax No. Property Address: Owner Unit Number Zip Code Email Address: Name: Fax No. GAIL LANGFORD Ph°V9-758-9829 Applicant Addre§�33 N MAGNOLIA AVE #112, SANTEE, CA Unit Number Email ASldlU SMITHELECTRICSD.COM Name:: Phone No. Fax No. Contractor Address: City State Zip Code N LIA AVE #112 SANTEE CA 92071 ontractor ty� sm s Icense o. Contractor's City State of Califomia License No. Classification: Number of Squares: / Square Footage Description of Work: EXISTING ELECTRICAL PANEL UPGRADE 200 AMPS OH Cost of Work:$ Applica Sign ur Date: 8 25/14 To Be Completed By City staff only 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 ❑ Goo Tech/Soils Report(on cd only) ❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 1/2 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' Meanslidethods Work Type: Repair' Retrofit• Revision to Fisting Permit' Required? YES NO Proposed Building Use(s): Ld 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 Sprinklered that apply: Coastal Zone Completion: T e s YP C or O YES or NO Noise Zone Required? ki Listed on Historic Resources Inventory CITY PLANNING STAFF ONLY APPROVALS: Costal Commiss Arch.Review Board I J Landmark Comm. Planning Comm.Zoning Administrator Fee Exempt: City Project Elec.Vehicle Charger Landmi lif. OmdalA royal Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing For Staff Use Only Building/Safety I Permit Specialist I Guy Planning I Civil Engineering I EPWM-Admin Transportation Mgmt. Rent control THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY