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PMT15-00905 I i R City of Menifee Permit No.: PMT16-00906 29714 HAUN RD. Type: Residential Electrical '�-�QCt;-A. ? MENIFEE, CA 92586 6anmaame Sollrow. MENIFEE Date Issued: 04I09/2015 i PERMIT Site Address: 29800 MORNING BREEZE DR, MENIFEE, Parcel Number: 339-391-010 CA92584 Construction Cost: $1,400.00 '.. Existing Use: Proposed Use: Description of MAIN PANEL UPGRADE 125A Work: Owner Contractor JOHN AMMANN SMITH ELECTRICAL CONTRACTORS INC 29800 MORNING BREEZE DRIVE 8733 N MAGNOLIA AVE 112 MENIFEE, CA 92584 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 Qtv Amount IS Services, Swltchtaoards Co trot Cente s&Panels ^ Aar 1 116G00 Building Permit Issuance 1 27.00 106, $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 1 ii V 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 —�` U License No. � E00 _ who builds or improves thereon, and who contracts for the projects with a a Expires 01 / Q 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. 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 • 7 "-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:httz)i//www.leginfo.ca.gov/calaw.html, permit is issued.My worker_s''�compensation Insurance carrier carrier and policy number are: Carrier E) cr)IfS 1 U CA � � I t S • Property Owner or Authorize gent Date Expires ,. ! 2Policy# —7uod oi `(71 LJOU I Name of Agent Phone# [I By my Signature below, I certify to each of the following: I am the properly 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 identifed 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 Code,I shall forthwith comply with those provisions. Property Owner or Authorized Agent Date _ Dat ;�4 .aJ°"" J pp--T�� 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, ❑YES -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 LgNO 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 ❑YES,. A PERMIT FOR THE CONSTRUCTION OR MODIFICATION Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT H 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 reasons)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, T� O 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 Slate 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 dcensure 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 UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL f)EPNNING. compensation, will do ( ) all of or( ) porting of the work, and the structure is PROPERTY" R OR AUTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a properly - X _ who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale), CITY OF MENIFEE PLCK No, Permit No: City of Menifee �5 29714 Haun Road Building & Safety Dept. Date: Date: Menifee, CA 92586 I S Phone: (951)672-6777 APR 0 9 2015 'mount: mount: Fax:(951)679-3843 Ck#: Ck#: Received Building Combination Permit To Be Completed By Applicant Legal Description: Planning Case: F: L: Rt: R: Property Address: i Assessor's Parcel Number. )"Clg o `'V1orwnc) �feeZe bf. l `'l a5V l _I- - C� Projectrfenant Name: Unit#t Floor#: Name: phone No. Fax No. �61�� Arr rv1 ct r1 r� Property Address: \ Unit Number Zip Code Owner C) n1 OrY11 r1C re ter• S p Email Address - Name: /t Phone No. r_ - _<. Fax No. Applicant Address: Unit Number Zi Code 8733 N MAGNOLIA AVE#112,SANTEE, CA P 92071 Email Address: ail smithelectricsd.com Name: Phone No. Faz No. SMITH ELECTRICAL CONTRQCTORS INC 619-758-9829 Contractor Address: City State Zip Code 92071 onVactor s ty Business icense o. Contractor's City State of California License No: Classiflcation- C-10 Number of Squares: Square Footage Description ofWork: EXISTING ELECTRICAL PANEL UPGRADE TO 1 AMPS Cost of Work:$ 1400.00 Applicant's Signature "-r Date: - F To Be Completed By City Staff Only Indicate As R-Received or N/A-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 ❑ Gan Tech/Sails Report(on call only) ❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 Y x 11) ❑ Structural Calculations ❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan it Single Line dlagram for elec.services over 400 AMP ❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential Class Code: Indicate New Construction Alteration` Addition` Means/Methods Work Type: Repair` RelrofIt` Revision to Fxlsfing Pelrrfit' 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 Indicate if fndicateall Geo-tech.Haz.Zone. At Project Indicate Spdnkleretl YES or NO Completion: Construction hat apply: Coastal Zone Type(s): C of o YES or NO Noise Zone Required? Listed on Historic Resources Inventory - CITY PLANNING STAFF ONLY APPROVALS: Costal Commis Arch.Review Board Landmark Comm. PlanningComm.Zoning Administrator Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit specfd case:Bldg. O(GdalA aval Expedite Project(s): Child Care City Project Green Building Landmadc Affordable Housing For Staff Use Only Building/Selety I Permit Specialist 1 City Planning Civtl Engineering EPWM-Admin I Transportation Mgmt. I Rent Control THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY