PMT14-03187 i
City of Menifee Permit No.: PMT14-03187
29714 NAUN RD.
Type: Residential Electrical
'�4G+GiEtl.,.,�i." MENIFEE, CA 92586
MENIFEE Date Issued: 12/05/2014
I,
PERMIT
Site Address: 29645 BOYNTON LN, MENIFEE, CA Parcel Number: 338-330-037
92586 Construction Cost: $1,500.00I.
Existing Use: Proposed Use:
Description of MAIN PANEL UPGRADE 200A
Work:
Owner Contractor
DONALD LIPPON VERENGO INC
29645 BOYNTON LANE 20285 S WESTERN AVENUE STE 200
MENIFEE, CA 92586 TORRANCE, CA 90501
Applicant Phone: 3108039053
STEVEN FARACLAS License Number: 935263
VERENGO INC
20285 S WESTERN AVENUE STE 200
TORRANCE, CA90501
Fee Description Qtyr Amount l$1
Services uvitckb4ard ;Cprf[oCCenr &Panels _ 11G,QD`I
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 qpd 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 C--00 License No.-f who builds or improves thereon, and who contracts for the projects with a
Expires r 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
❑ 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
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:hftp�//www.IeQinfo.ca.gov/calaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier" -A-9Q— c"hr Property Owner or Authorized Agent Date
Expires /k� �Q l/y 5 Policy# f 2-55
i 1 ��4-ccPhone# �f6 (0`5 Z 6 yO ❑ By my Signature below, I certify to each of the following: I am the property
Name of Agent 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-
fP 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.
Z(5�
Date; Applicant;l.JCTl-i='-TJC<::, 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, 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 I�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 DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address GLNO 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 items)(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, 0 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 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($500).) CODE SECTION
E STI O ERIALSI�E 5533OR1,AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole
compensation,will do ( )all of or( ) porting of the work, and the structure is PROPEOc NT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's Stale License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF NI E 1 i(T I E E, PLCF:No:
(Perrm1i:No:
29714 Haun Road Cltyof Menifee Date: Date.
_�
Menifee, CA 92586 Building & Safety Dept. \a`5 I ILA
Phone: (951 )672-6777 �'O'un` Amount
Fax:(951)679-3843 DEC 0 5 2014
Ck,"".. Ck k.
Building Combination P Igeived
To Be Completed By Applicant
Legal Description: To
Case. F: .
properAae Assessor's Parcel Numl:er.ProjecU . 03
.Tenant Name: Una 1: Floor
Name:
L IN (. MC'3 Pone :o. Fax No.
Pr°Pen% Address�JON lCt9 cr
Owner2at6`kS ZLp tJTprJ C.N Uni;Number Zip Crde 1ZS
Email Address: '
Name: 75 lEjaA-) � Ct S Phone plo. Fa<No.
Address: 318 -(;S 1 �S
Applicant ?�J 'vl .7� !1.r __/ Uni,P:um er Zip Code
Email Addra3 (t�T �l -�F G
�•tca
N 3me: U� Pnone No. Fat No.a �0 803 Boss
Cortraz;or Address: Zin Cod=_
2�2SS `5- Wc'StcRN 2 CcC�-:? A)Cc � C c4aSot Con cra::!or's Cie/ BuSi nass Lic--nnse P20. Ccrt:aclo.'s CI 'la'of Califrnnia License No. ClassiCca;i
5`'26 Cll'�
Number of SGmres:
S-AJwe FaJ�3ga
Descri?5un of INor'r.: QOO-/�T So
-�A 2�i rioyc.ES 7J-t 1-Cr S,<{3 os;of V/3'..
Applicant's Signatur -C•�Z— � cdo--t �Q.Z�-$� 25,c7po
Date: /Z
To 6c ComplN.=d ey City Sta�f Only' - ,. .
Indicate A5 P. Re,ei,eJ er NIA-Not Ap Pcabte
5 C.r..J.�+s'L o:L, di ramicnes r'-a:n to sa I r ,Rich dud- p
❑ P;ta Sheet ❑ Eleyatiocs ❑ El=cvica!Plan ❑ Gen Ter:N'Scils R_port(on cd only)
❑ Plot/site Plan ❑ Roof PI=_n. ❑ M1lechanical Plan ❑ Tide 24 En.rgy(on 8 t5 x 11)
❑ Foundation Plan ❑ Cross Saction ❑ Pinnhing Plan ❑ S'ru tural Calcu:a:i„r.s
❑ Single Line didgr3m for elec.services over LCU AMP
❑ Floor Plan ❑ Sln:cturJ Framing Plan 3 Delals ❑ Shoring Plan ❑ Sound ^Raper,-Residential
Class Cede: Indicate ,low Construction Altarticn' Adu'ition'
7.. 3n„th'Scd�
Work Type: Repair' RelroGl' 'z:iszn to Ecsl na Pari1• Rzgwere ? YES NO
Propcs..d Building Use(s)' -
Eristing 5.:il,ing Usti(s)
=HailJ ngs: ". Unh,: 'Srr'.es Will the Building 113ve a laser:..-.•�
Hid. Coda! Orc:pency Gr;,n Y at FI
3 ' I I 'r ate 1 l a it YES or NU lndica.e 31 C c ch H3z Z_r-
C, rTv:2( I ('�r ;rt.];Un 5 r ,. .red lh„I a:;lay: Coastal 1]I Zone
Corn, Gor,�
T/f (s)- r Of 0 N-ia,Zono
.,a r•r:? YES or t10
C!i'/?L:?r;>ll P; STAFF GAILY
�.PPPoJ`/._.LS' Mk4Ar:h. P._•'de:•r Board Lar,d,nar<Cor.,ru. Plarninu Crmr! ';n n7:,,;:Rini,:r
Fe Gx ar.p:. I. , r 'ir!••Ch'ag'r I and:uar'.C:;ae ,,-a , ). nr f'rcl'=c' Gr.�en CuiLJin9 J Laminar -..-,