PMT15-00934 City of Menifee Permit No.: PMT16-00934
29714 HAUN RD, Type: Residential Electrical
CCIEI A— MENIFEE, CA 92586
c�emxvu smiw�." MENIFEE Date Issued: 04/1412015
PERMIT
Site Address: 28146 LOOKOUT POINT LN, MENIFEE, Parcel Number: 333-393-034
CA 92585 Construction Cost: $2,000.00
Existing Use: Proposed Use:
Description of INSTALL 50 AMP GFCI SUB PANEL FOR PORTABLE SPA
Work:
Owner Contractor
ROGER RUPP M J BUILDERS SPAS
28146 LOOKOUT POINT LN 5527 WENTWORTH DRIVE
MENIFEE, CA 92585 RIVERSIDE, CA 92505
Applicant Phone: 9519065656
MARC SANCHEZ License Number: 905531
M J BUILDERS SPAS
5527 WENTWORTH DRIVE
RIVERSIDE, CA 92505
Fee Description (sty Amount I$1
Receptacle Swdch Outlet&Fixture 1 116 00
Building Permit Issuance � 1- - ..� � �27.00.
GREEN FEE mT 1 1.00
$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_Bltlg_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 and y license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class — S License No. U 55 31 who builds or improves thereon, and who contracts for the projects with a
Expires (D- 3(^(5 Signature llei 7-""`'y'-''-= 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
❑ 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. 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
❑ 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:htta'//www leg!nfo.ca.Clov/calaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Property Owner or Authorized Agent Date
Carrier
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-
t I certify that in the performance of the work for which this permit is issued, I identified property for the inspection purposes.
all not emolov 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 er P.uthenzed Agent Date
Code, I shall forthwith comply with those provisions.
C =�--� „� City Business License#
Date; `I "-� Applicant; GT_,
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 NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY r SPECIFIED ON THE HAZARDOUS MATERIALS
INFORMATION GUIDE?
I hereby affirm that under the penalty of perjury there is a construction lending
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
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address NO 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 AYES 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 ,NO 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($500).) HAZARDSECTION
US ON 25505ATERIAL f�E 5533',AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole
compensation, will do ( )all of or( ) porting of the work, and the structure is PROPERTY OWN R OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale. If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
SAFETYBUILDING & APPLICATION
Menifee
DATE — — PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL XRESIDENTIAL 0 MULTI-FAMILY CC> MOBILE HOME 0. POOL/SPA ()SIGN
SUBTYPE: O ADDITION C)ALTERATION 'O DEMOLITION ELECTRICAL C) MECHANICAL
C. NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS 2 Lob „-�- PLAA
2
ASSESSOR'S PARCEL NUMBER 333' �� LOT loa TRACT
OWNER NAME P,z:lg Z LA
ADDRESS 2 L
PHONE J 1 -Z3(0- l g!q I EMAIL
APPLICANT NAME KA
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME V4CkIf L C'. V�G',(ti! OWNER BUILDER? C)YES tNO
BUSINESS NAME M E+ s S
ADDRESS CC ALl..f1 1
PHONE ' lS\ � S6S6 EMAIL
CONTRACTOR'S STATE LIC NUMBER _\b s LICENSE CLASSIFICATION e 53
VALUATION$ 2,(D OC> . O CD ' SO FFTy L SO FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT " CASH CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT ".) CASH :'CHECK# `.)CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 'D YES O NO DL NUMBER NOTARIZED LETTER YES B NO
City of Menefee Building& Safety Department 29714 Houn Rd. Menefee, CA 92586 951-672-6777
www.cityofinenifee.Lis Inspection Request Line 951-246-6213
I
City of Menifee
Building & Safety Dept.
3 m APR 14 2015
M
�m Received
S�bvr,�?
7gl ila �bnr„PVT PN i Q.)
Li
! CITY OF MENIFEE
BUILDING ANDSAFETY DEPARTMENT
PLAN APPROVAL
I f,
Su6PNtri REVIEWED BYQJAX
a,,,p DATE
GT c
'Approvalo t ese al ans shall not Lie caa rue ,o z a permitfbr or art—
approval of,any violation of any provisions of the federal,state or city
regulations and ordinances. This set of approved plans must be kept on the
jobsite until completion.
N �
i
SPA
- _o �� n
Fun