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PMT15-00815 1 City of Menifee Permit No.: PMT15-00816 29714 HAUN RD, Type: Commercial Electrical 'cACCEEI.A— MENIFEE, CA92586 MENIFEE Date Issued: 04/16/2015 III PERMIT Site Address: 26660 ENCANTO DR, MENIFEE, CA Parcel Number: 331-120-065 92585 Construction Cost: $1,500.00 Existing Use: Proposed Use: Description of REPLACE 6 EXISTING OUTLETS INSIDE STORE Work: Owner Contractor DONALD SHELDRAKE-POLLY INC. SUPERIOR ELECTRICAL MECHANICAL& 2660 N MAIN ST PLUMBING INC SANTA ANA, CA 92705 8613 HELMS AVE Applicant Phone: 9093579400 DANIEL CANTERO License Number: 911185 SUPERIOR ELECTRICAL MECHANICAL&PLUMBING INC 8613 HELMS AVE RANCHO CUCAMONGA, CA 91730 Fee Description 0yt Amount XReceptacle Swdch Outlet&Fudue Bui Siv y �4100y lding Permit Issuance 1 27.00 $169.00 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 sI of Divisio6Vf�k usiness nd contractors to construct the project(Section 7044, Business and Professions Professio e ryy��cenprd Code:The Contractor's License Law does not apply to an owner of a property License las (( �,,�J Lic who builds or improves thereon, and who contracts for the projects with a Expire Z �pignatur licensed contractor(s)pursuant to the Contractors State License Law). WORKE S'CO PENSATI ❑ 1 am exempt from licensure under the Contractors'Slate 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 of legally sell a structure that I have permit is issued. built as an owner-buildin it has not been c structed in its entirety by licensed Policy# co ctors. I understa th t a copy of the ap Iicable law, Section 7044 of the l%- I have and will maintain workers' compensation insurance, as required by B in e s and ssic s ,is available up n request when this application is section 3700 of the Labor Code, for the performance of the work for which this s mitt r the ing W si :/ .le info.ca. ov/ Iaw.html. permit is issued.My workers'com ensation insurance carrier and policy number are: cs, (� � �S 1\ c Pro art o uthori dDate Carrier K— �` CJN` Expires (�L )�-� Policy# //��� Phone 0- ES By my Signature below, I certify to each of the following: I am the property Name of Agen � � 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 pr ided is correct. I agree to comply one-hundred dollars($100)or less) with all applicable city a unty ordinance and state laws relating to building c n uction.I thoriz r p entatives of thi city or county to enter the above- 0 1 certify that in the performance of the work for which this permit is issued,I id nti d prop rty t e i ction purposes. shall not emolov any persons in any manner so as to become subject to the workers'compensation laws of California, and agree t I shoul e ; subject to the workers'compensatifn ' 'ons a lion 00 the Lab r property wne or Authorized Agen to Code, shall forthwith comply with tov io s. � 5City Business Li ense#Date; ( Applic WARN NG: FAILURE TO ECURE WORKERS' HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE IS UN WFUL, 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 RK0_ 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 "V DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDE LINES OWNER BUILDER DECLARATIONS 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, 2'46 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 DYES 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 O U ER THE STATE OF CALIFORNIA HE AND SAFETY a civil penalty of not more than($500).) tPE , SECTION 2550 3 A 5534 C CERNING ❑ I, as owner of the property, or my employees with wages as their sole OUS M IA EP. �I compensation,will do( )all of or( )porting of the work, and the structure is W ER O AUTH IZED 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 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).