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PMT15-01136 City of Menifee Permit No.: PMT16-01136 29714 HAUN RD. MENIFEE, CA 92586 Type: Residential Electrical MENIFEE Date Issued: 04/30/2016 PERMIT Site Address: 25720 HARTWICK RD, MENIFEE, CA Parcel Number: 339-072-009 92586 Construction Cost: $3,500,00 Existing Use: Proposed Use: Description of MAIN PANEL UPGRADE 125A-FOR SOLAR PERMIT#PMT15-01137 Work: Owner Contractor _ PETER CABRINHA BLALOCK ELECTRIC&SOLAR INC 25720 HARTWICK ROAD 23905 CLINTON KEITH ROAD MENIFEE, CA 92586 #114-216 Applicant Phone: 9517604638 NICK BLALOCK License Number: 915397 BLALOCK ELECTRIC &SOLAR INC 23905 CLINTON KEITH ROAD #114-216 WILDOMAR, CA92595 Fee Description Qty Amount($) '"�IC2S-`-S4VItGhbQfdS Q tf,Ql Cee�9fS,a$` eS r:��„3i,.'.� `" �+'xwmm£,: 50.�1 600.s: 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_Templatexpt 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 my license is in full force,and effect. Code:The Contractor's License Law does not apply to an owner of a property License Cla s )D License No, c 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 IT I am exempt from Iicensure under the Contractors'Slate 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 se tion 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http•//www.leginfo.ca.gov/calaw,htm], permit is issuued.M1y workers'compe anon insurance carrier and policy number are: Carrier C / Property Owner or Authorized Agent Date Expires �d �'�.. / � Policy# 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 owndr'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 identified rope for the inspec on p rposes. 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, shall) shall fort ply with those provisio S. Property Owner or Authorized Agent Date _ d� City Business License# G Date; � Applicant; 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 AHAZARDOUS MATERIAL ORA DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE ,v MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES p 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 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 i FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address NO 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 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, 0 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 ❑Y S INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from Iicensure and the basis for the alleged exemption. Any 7( CHECKLIST. I UNDERSTAND MY REQUIREMENTS violation of Section 7031.5 by any Applicant for a permit subjects the applicant to `0 UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING El I, as owner of the properly, or my employees with wages as their sole HAZARDOUS MATERIAL REPrr B ING. compensation, will do ( ) all of or( ) porting of the work, and the structure is PROPERTY OWNER QR'AUTHODA GENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). PERMIT/PLANBUILDING & SAFETY CHECKAPPLICATION DATE t Q PERMIT/PLAN CHECK NUMBER TYPE: ❑COMMERCIAL RESIDENTIAL MULTI-FAMILY ❑MOBILEHOME POOL/SPA ❑SIGN SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION QELECTRICAL ❑MECH$NICAEvenIfBB ❑NEW ❑PLUMBING El RE-ROOF-NUMBER OF SQUARES Sullding <s oafety DOP DESCRIPTION OF WORK APR 3 O 201b (1) 125A service upgrade Q- ',`,- T1 M 5—D //3 7 PROJECTADDRESS 25720 HARTWICK RD.SUN CITY,CA 92586 ftecuiveli- ASSESSOR'S PARCEL NUMBER f2Scl --0'7 L— 0()Cli LOT l-7Z TRACT �ZLI OWNER NAME PETER CABRINHA ADDRESS 25720 HARTWICK RD.SUN CITY,CA 92586 PHONE (951)216-5076 EMAIL APPLICANT NAME Nick Blalock ADDRESS 23905 clinton keith rd.#114-216 Wildomar CA 92595 PHONE (951)760-4638 EMAIL blalockeleotric@yahoo.com CONTRACTOR'S NAME Blalock Electric&Solar inc. OWNER BUILDER? ❑YES❑✓NO BUSINESS NAME Blalock Electric&Solar inc. ADDRESS 23905 clinton keith rd.#114-216 Wildomar CA 92595 PHONE (951)7604638 EMAIL blalockelectdc@yahoo.com CONTRACTOR'S STATE LIC NUMBER 915397 LICENSE CLASSIFICATION C-10 VALUATION$ $3,500.00 S% 217 LSQ FTT>- APPLICANT'S SIGNATURE ��'�-�� DATE 0442015 DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN ,' SMIP X INVOICE PAID AMOUNT AMOUNT \ y C CASH C CHECK# 0 CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT <;CASH C CHECKk O CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES C NO DLNUMBER NOTARIZEDLETTER C YES C NO nl �;1err�, Suildin & Sofety D�plTr-trnGnt797:k: Fin r,d. nn n% A 957-572-6777 bvsvi„.cityojmr'?nif- e Ls !n_=��crinn F?ec,l ��t LM.� c I ,6-f>>13