PMT15-01009 City of Menifee Permit No.: PMT15-01009
29714 HAUN RD. Type: Residential Electrical
C1 MENIFEE, CA 92586
motM" " MENIFEE Date Issued: 0412 0/2 01 5
PERMIT
Site Address: 25684 MOTTE CIR, MENIFEE, CA 92585 Parcel Number: 329-371-005
Construction Cost: $1,000.00
Existing Use: Proposed Use:
Description of MAIN PANEL DOWNGRADE TO 175A
Work:
Owner Contractor
BARNEY&TERESA FRANK
25684 MOTTE CIRCLE
MENIFEE, CA 92585
Applicant License Number:
BARNEY&TERESA FRANK
25684 MOTTE CIRCLE
MENIFEE, CA 92585
Phone:7148833840
Fee Description (3,yt Amount
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 iVI, 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 License No. 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
❑ 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
permit is issued. improvements covered by this permit, I cannot legally sell a structure that I have
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 nd Professions Cad available upon request when this application is
section 3700 of the Labor Cade, for the performance of the work for which this submitte or at the toJlaN}ng e site:hit ://www.le ,nfo.ca. ov/calaw. .
permit Is issued.My workers'compensation insurance carrier and policy number are: !U/GG//
Carrier Pr R aror Authorize Agent Date
Expires Policy#
Name of Agent Phone# ❑ By my Signature below, I certify to each of the fallowing: 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 slate laws relating to building
construction. I authorize representatives of this city or county to enter the above-
0 I certify that in the performance of the work for which this permit is issued, I identified p operty for the in et purposes.
shall 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 Pr ert v r or Authorized A nt Date
Date; Applicant;
Code, I shall forthwith comply with those provisions.
City Buy ess 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, OYES 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 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 3097 Civil Code) WILL THE INTENDED USE OF THE BUILDING BY THE
APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE -
Lender's Name OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
ElNO 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 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 OYES 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 ($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL IkEPOR1ING.
compensation,will do( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
41y
'"Menifee
AdIll
DATE PERMIT/PLAN CHECK NUMBER
TYPE: []COMMERCIAL ❑✓ RESIDENTIAL []MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION []DEMOLITION ❑✓ ELECTRICAL ❑MECHANICAL
[—]NEW [—]PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Existing 200A main service disconnect to be De-Rated to 175A City O8.f Menifee
RUiICI,See sheet PV-3.1 on plans for Electrical Load Calc.
PROJECT ADDRESS 25684 Motte Cir, Romoland, CA 92585
ASSESSOR'S PARCEL NUMBER 329-371-005 LOT 9 TRACT 29493eceive
OWNER NAME Barney&Teresa Frank
ADDRESS 25684 Motte Cir, Romoland, CA 92585
PHONE (714)883-3840 EMAIL barneyfrankcsb@yahoo.com
APPLICANT NAME Barney Frank
ADDRESS 25684 Matte Cir, Romoland, CA 92585
PHONE (714)883-3840 EMAIL barneyfrankcsb@yahoo.com
CONTRACTOR'S NAME OWNERBUILDER? AYES❑NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LLII�CNUMBER LICENSE CLASSIFICATION
VALUATION$ $ w* d U SQ FT 2,887 L SO,FT 0.19 Acres
APPLICANT'S SIGNATURE DATE 4 ZY//S'
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP X
INVOICE pglD AMOUNT
AMOUNT y OCASH GCHECK# CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNTGCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES :) NO DL NUMBER NOTARIZED LETTER 0 YES () NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213