PMT15-01232 City of Menifee Permit No.: PMT16-01232 I
29714 HAUN RD. Type: Residential Electrical
MENIFEE, CA 92586
MENIFEE Date Issued: 05/11/2015
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PERMIT
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Site Address: 26379 RIDGEMOOR RD, MENIFEE, CA Parcel Number: 337-212-004
92586 Construction Cost: $1,300.00
Existing Use: Proposed Use: III
Description of ELECTRICAL PANEL UPGRADE TO 125AMP �i
Work:
Owner Contractor
THOMAS SUBLETTE HOWARD ELECTRIC
26379 RIDGEMOOR RD P 0 BOX 3312
MENIFEE, CA 92586 HEMET, CA 92546
Applicant Phone: 9513774481
DESARAE JOHNSON License Number: 817316
HOWARD ELECTRIC
P 0 BOX 3312
HEMET, CA 92546
Fee Description P!Y Amount($
e a:e Y g:..
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 ❑ 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 C.- (0 License No.
''_'1-131 la who builds or improves thereon, and who contracts for the projects with a
Expirelb S 15 Signature !'S-ate'" 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
fly 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
❑ 1 have and will maintain workers' compensation insurance, as required by Business and Professions Cade,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:Ii //www.le linfo ca oov/calaw html.
permit is issued.My workers'compensation insurance carrier and policy number are: A
Carrier S-I.y-'� - �VV1 C� Property Owner or Authorized Agent Date
(.Expires a - 11 �_.l Policy# mH Jl 53
❑ 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-
0 1 certify that in the performance of the work for which this permit is issued, I identified property for the inspection purposes,
shall not employ any persons in any manner so as to become subject to the p
workers' compensation laws of California, and agree that if I should become n.7e-
subject to the workers'compensation provisions of Section 3700 of the Labor Property Owner or Authorized Agent Date
Code, I shall forthwith comply with those provisions. Q
II %�� verve City Business License#
Date; I( Applicant;`yt
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 [I NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY 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 pYES 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 PRINT NAME:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the reason(s)indicated below by the checkmark(s)I have placed pYES 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 I HAVE READ THE HAZARDOUS MATERIAL
provisions of the Contractor's State License Law (Chapter 9 (commencing with
Section 7000)of Division 3 of the Business and Professions Code)or that he or pYES 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 penally of not more than($500).) HCODE ECTION 255L5ffE5533 G AND 25534 CONCERNING
❑ 1, as owner of the property, or my employees with wages as their sole
compensation, will do ( )all of or( ) porting of the work, and the structure is PROPERTY OWNER ORAUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code; Q� � -.,.
The Contractor's State License Law does not apply to an owner of a property X b`r/
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
I
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PERMIT/PLANBUILDING & SAFETY APPLICATION
4
Menifee
DATE 5 " LS PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL ! MULTI-FAMILY O MOBILE HOME C, POOLISPA C'SIGN
SUBTYPE: C`ADDITION O ALTERATION r,DEMOLITION 0 ELECTRICAL C) MECHANICAL
O NEW Ci PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Q-nt U r0.c(-e- 3 12S 4
PROJECT ADDRESS UO3r jkt emo re,, I2CI, Mle t-G
ASSESSOR'S PARCEL NUMBER -3?nf 1�'M' LOT g I TRACT p4
OWNERNAME llornaS b
SL) le+4-e ,
ADDRESS 2 //.�C 3_19 KI a trh00 /0,
PHONE 151. Co79. //%1-1 ' _ EMAIL
APPLICANT NAME TLc' 1'Icl - I t1w e cLra.e
ADDRESS 0 , Box 3
PHONE 9S/- 37.7. Y481 EMAIL rhowar d e /eC4rL'C @a6
CONTRACTOR'S NAME nc(r �ujcx.v-& OWNER BUILDER? O YES O NO
BUSINESS NAME fTO UJ cZ, A IF 1 e C rr 1
ADDRESS • O . Un [2
PHONE 9 S/ .*�-77- 41 q g I EMAIL
CONTRACTOR'S STATE LIC NUMBER g(731(p LICENSE CLASSIFICATION �C5
VALUATION$ /30 Q SO FT L SO FT
APPLICANT'S SIGNATURE DATE
1
DEPARTMENT DISTRIBUTION 00 CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP Q 3Sg5
INVOICE PAID AMOUNT
AMOUNT 1 C� CASH < CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# )CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0'YES O NO DL NUMBER NOTARIZED LETTER O YES Ci NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-5777
www.cityofinenifee.us Inspection Request Line 951-246-6213