PMT14-03053 II
City of Menifee Permit No.: PMT14-03053
29714 Type: Residential Electrical
�CC�.-/�^.` MENIFEE,EE, CA 9292586
MENIFEE Date Issued: 11/18/2014
1
PERMIT
Site Address: 29924 GIFHORN RD, MENIFEE, CA Parcel Number: 339-311-015
92587 Construction Cost: $1,400.00
Existing Use: Proposed Use:
Description of MAIN PANEL UPGRADE 125 AMP
Work;
Owner Contractor
GARY PREWITT SMITH ELECTRICAL CONTRACTORS INC
29924 GIFHORN ROAD 8733 N MAGNOLIA AVE 112
MENIFEE, CA 92587 SANTEE, CA 92071
Applicant . Phone: 6197589829
RANDY COLE License Number: 871200
SMITH ELECTRICAL CONTRACTORS INC
8733 N MAGNOLIA AVE 112
SANTEE, CA 92071
Fee Description ,O�t Amount
Building Permit Issuance 1 27.00
G
$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_eldg_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 4 License No. 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 DECLARATION
❑ I am exempt from Iicensure 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, cannot legally sell a structure that 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
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:httr)://www.leoinfo,ca.aov/calaw,html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier &-.;)L-5T /_.J Property Owner or Authorized gent Date
r'
Expires [d/.7 Policy# 1 '7o1J!q.1
Name of Agent Phone# ❑ By my Signature below, I certify to each of the following: I am the property
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 Section 3700 of the Labor property Owner or Authorized Agent Date
Code, I shall forthwith comply with those provisions.
Date; Applicant;, City Business License#
WARNING: FAILURE T 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, ❑YES OCCUPANT HANDLEA HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑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
Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
El 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 []YES 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 []YES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from Iicensure 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 ($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL I'{EPORI'ING.
compensation,will do ( ) all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF MENIFEE PLCK No: Permit No:
29714 Haun Road City of Menifee �tA 3
Building & Safety Dept. Date: Date:
Menifee, CA92586 l\
Phone: (951)672-6777 NOV 18 2014 Amounb Amount:
Fax:(951)679-3843 tNui-
Ck#: Ck#
Building Combination Permit
To Be Completed By Applicant
Legal Description: Planning Case: F: L: Rt: R:
Property Address: 29924 Glfhorn Rd Assessor's Parcel Number. 339311015
Project/Tenant Name: Unit#: Floor#:
Name: PreWltt, Gary F(619)248-6417 Fax No. _
Property Address:
Owner 29924 Gifhorn Rd Menifee 92587 Unit Number Zip Code 92587
Email Address: -- --
Name: Rand Cole Fax No.
Y P619-405-2648
Applicant Address: Unit Number Zip Code
Email Address:
Name' Smith Electrical Contractors Pt°"(619)758-9829 Fax No.
Contractor Address: 8733 N Magnolia Ave#112 clhSantee Ste CA ZiP Cad
92071
Contractor's City Business License No. oontractor's City State<871200 - In- Cz-SIF C10
Number of Squares:
Square Footage
Description of Work: co Panel upgrade to 125 Amp st of work:$ 1400.00
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 ❑ Gen Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8%x 11)
Cross Section
Foundation Plan El 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' Addibon• Means/Methods
Work Type:HRepair* Retrofit• Revidonto E)dstlng Pemlir Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: If 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 Sprinklered YES or NO
Completion: Construction that apply: Coastal Zone
Type(s): C of o YES of NO Noise Zone
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss lArch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: CAy Project Elec.Vehicle Charger Landmark Seismic Retrofit Swclal Case:Bmg_
OffiaalApproval
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Building/Safety I Permit Specialist Cily Planning ICivil Engineering EPWM-Admin Transportation Mgmt. I Renl Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY