PMT15-00904 y
City of Menifee Permit No.: PMT15-00904
29714 HAUN RD. Type: Residential Electrical
'sr'ICG :1..f MENIFEE, CA 92586
MENIFEE Date Issued: 04/09/2015
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PERMIT
Site Address: 29632 VIA NARAVILLA, MENIFEE, CA Parcel Number: 336-232-018
92586 Construction Cost: $1,400.00
Existing Use: Proposed Use:
Description of MAIN PANEL UPGRADE TO 125A
Work:
Owner Contractor
SANDRA McCANCE SMITH ELECTRICAL CONTRACTORS INC
29632 VIA NARAVILLA 8733 N MAGNOLIA AVE 112
MENIFEE, CA 92586 SANTEE, CA 92071
Applicant Phone: 6197589829
ARIEL BROSAMLE License Number: 871200
SMITH ELECTRICAL CONTRACTORS INC
8733 N MAGNOLIA AVE 112
SANTEE, CA 92071
Fee Description QQtr Amount
,Services (Swltchboaras Control Centers&i�anels 1i � (16 b0
Building Permit Issuance 1� 27.00
1 A4_
$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
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City Of Menifee
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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 once and effect. Code:The Contractor's License Law does not apply to an owner of a property
License ClassC_i License No. 1-n() 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
❑ 1 am exempt from licensure under the Contractors'State License Law for the �I!
❑ I hereby affirm under penalty of perjury one of the following declarations: following reason: li
I have and will maintain a certificate of consent of self-insure for workers' By my signature below acknowledge that, except for my personal residence in
compensation,issued by the Director of Industrial Relations as provided for by which must have resided for at least one year prior to completion in
Section 3 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
of
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
IC12^'I 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:llwww leginfo ca ciov/calaw html,
permit is issued.My workersl'co pmpe�nsation insuranycce,carrier and policy number are:
Carrier L� r✓(�,eS7( Ill�� ) ' I t 5 + )Property Owner or Authorized Agent Date
Expires ' 0 1/2. 15 Policy# U 00 0c
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-
0 1 certify that in the performance of the work far which this permit is issued, I Identified property for the inspection purposes,
shall not emolov any persons in any manner so as to became 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
Code,I shall forthwith comply with those provisions. P Y Agent Date
Dat -' Applicant; 1 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, AYES -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 Ig..N(5 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 8 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 ❑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, `MO 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 EUQ/ 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 REPORT ING,
compensation, will do ( ) all of or( ) parting of the work, and the structure is PROPER T R 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 ME IFE Li of Menifee PLCK No Permit No:
29714 Haun Road Mn)g & Safety Dept. (�
1 I I
Menifee, CA 92586 APR 0 9 2015 Date: Date: `1
Phone: (951)672-6777
Fax:(951)679-3843 ck#: k#:
Received
Building Combination Permit
To Be Completed By Applicant
Legal Description: Planning'Case:- F: L: 14 R:
Property Address; Assessor's Parcel Number.
qii- " Vl(-i 0.rclvi )i)a sun C k 1A ` -XS
ProjecVT nY�C Name: r„� (r C-0.nG f.IIc�Y'G\ I t I e— Unit#: Floor#:
Name: \ 1 y. M C C C Phone No. Fax No.
Proprty Owner Address: C1p A Unit Number Zip Code
EmailAddres�(-T - -
Name: ((�� - PhoneNo: ('�
Airy e li lz v scLyY� � � (Ci �1 ISO _c � cf Fax No.
Applicant Address :
pp $733 IN MAGNOLIA AVE#112,SANTEE,CA Unit Number Zip Code 92071
Email Address: - - -
ail smithelectricsd.com
Name: Phone No. Fax No.
SMITH ELECTRICAL CONTRQCTORS INC 619-758-9829
Contractor Address: 'City State Zip Code
'AA ISANTEE
12
92071
ontractor s -.rty Business icense o. Contractor's City State of Califomia.License No Classification.:
_.. . . . . 871900 C-10
Number or Squares:
Square Footage
Description of Work: EXISTING ELECTRICAL PANEL UPGRADE TO r�' AMPS Jost
Work:$ 1400.00
Applicants Signature Dam_
L�_cj — IS
Indicate As R=Received rx 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 ❑ Goo Techiso!Is Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Tide 24.Energy..(on 8%x 11)
Foundation Plan ❑ Structural Calculations
❑ ❑ Cross Section ❑ Plumbing Plan
❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Struchad Framing.Plan&Details ❑ Shoring.Plan ❑ Sound Report-Residential
Class Code: Indicate New Construcgon Alteration' Additioh• MeanslMeUmds
Work Type' Repair- Retrofit' Revision to F-xisfing Perth Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have.a Basement?
Y of N
Bldg.Code Occupancy Group I IndigteH Geo-tech.Haz.Zone
Indicate YES or NO that apply:)
At Project Construction Spdnklered that apply: Coastal Zone
Completion:
Type(! C tx O YES or NO. Noise Zone
Required? Listed on Historic Resources.Inventory
:CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project IIlElec:Vehicle Charger Landmark Seismic Retrofit specs case:amq.
O(faa!A mvat
Expedite Project(s): Child cam City Project Green BuBtling. Landmark Affordable Housing
For Staff Use Only
Building/Safely Permil Specialist 1 City Planning I Civil Engineering I EPWM-Admin Transportalion Mgmt. Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY