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PMT14-03100 i 1 i City of Menifee Permit No.: PMT14-03100 29714 HAUN RD. Ii '9iCCELA> MENIFEE, CA 92586 Type: Residential Electrical MENIFEE Date Issued: 1 2104/2 01 4 f PERMIT Site Address: 25514 ORION CT, MENIFEE, CA 92586 Parcel Number: 339-164-015 Construction Cost: $2,000.00. Existing Use: Proposed Use: Description of MAIN PANEL UPGRADE FROM 100 AMP TO 200 AMP Work: Owner Contractor JOSEPH D. MEHELIC SIEPKER ELECTRIC 25514 ORION COURT 22755 GRAY FOX MENIFEE, CA 92586 CANYON LAKE, CA 92587 Applicant Phone: 9517575119 SHAWN SIEPKER License Number: 899603 SIEPKER ELECTRIC 22755 GRAY FOX CANYON LAKE, CA 92587 Fee Description QtV Amount N 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 bulliding operations being carried on thereunder when in violation of the Building Code or of any other ordinance of City of Menifee. Except as otherwise slated,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. CONDITIONS Condition Comment 1 C10 AA_Bldg_Permit_Template.rpt Page 1 of 1 City Of Menjfee 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 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 ❑ lam exempt from Iicensure 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. 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 ❑ 1 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:http�/lw leciinfo.ca.gov/calaw.html. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier Property Owner or Authorized Agent Date Expires Policy# ❑ 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- Q/1 certify that in the performance of the work for which this permit is issued,I identi property for the spec n 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 uthor ed Agent Date Code,I shall forthwith comply with those provisi ,I Date; /2"'7 '" /5 Applicant; City Business License# 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 OR A DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES "0 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 O 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 OYES 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, `kLNO 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 jffy.ES 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($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL ff EPOR1ING. compensation,will do ( )all of or( ) porting of the work,and the structure is PROP OWNE R AUTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, - provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion,the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK Menifee Building & Safety IJuV 20 20 Lil1 'r DATE PERMIT/PLAN CHECK NUMBER J�(- {�eCP.IVed TYPE: COMMERCIAL RESIDENTIAL MULTI-FAMILY MOBILE HOME 0POOL/SPA -SIGN SUBTYPE: ADDITION ALTERATION DEMOLITION X ELECTRICAL MECHANICAL NEW PLUMBING '.: RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK L 4 /7 %V PROJECTADDRESS 45 ILI L)j2jom CpUjq7,4In FEE GA 9Z5 ASSESSOR'S PARCEL NUMBER 23q.1 GL'0J tidy LOT 5_3 TRACT OWNER NAME fJ r/ m-14&LI C, ADDRESS 2,5 J C IZ I Ot3 60" RT /I EAf 1 rE,6�,1, 614 PHONE 961- 53�'- /363 EMAIL W heli;L Cl-' v' r! Yle C APPLICANT NAME Tonpj7J4 / - ADDRESS 4ij L '( /V CD ME) PHONE qS-1-S3 - J363 EMAIL (f eLQtr y'I CONTRACTOR'S NAME r `p OWNER BUILDER? 9 YES --:?NO BUSINESS NAME ADDRESS PHONE g57-1- -75-7- ,S'// g EMAIL 1G.Er ,' /, C CONTRACTOR'S STATE LIC NUMBER q (0 6'3 LICENSE CLASSIFICATION G -- / VALUATION$ Q O SQ FT L SQ FT APPLICANT'S SIGNATURE DATE ��2 L7 CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION t CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE 1 L A L-� PAID AMOUNT � AMOUNT `q q CASH °CHECK# $CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT CASH '.%CHECK# CREDIT CARD VISA/MC OWNER BUILDER VERIFIED "3 YES NO DLNUMBER NOTARIZED LETTER YES C' NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213