PMT15-01352 9
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City of Menifee Permit No.: PMT15-01352
29714 HAUN RD. Type: Residential Electrical
916CEL1k? MENIFEE, CA 92586
MENIFEE Date Issued: 05/1912015
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PERMIT
Site Address: 28612 CORVUS WAY, MENIFEE, CA Parcel Number: 339-213-022
92586 Construction Cost: $1,400.00
Existing Use: Proposed Use:
Description of ELECTRICAL PANEL UPGRADE TO 125 AMPS FOR SOLAR PERMIT PMT15-00506
Work:
Owner Contractor
BILL HOLLOWAY SMITH ELECTRICAL CONTRACTORS INC
28612 CORVUS WAY 8733 N MAGNOLIA AVE 112
MENIFEE, CA 92586 SANTEE, CA 92071
Applicant Phone: 6197589829
EMILY FORSTER License Number: 871200
SMITH ELECTRICAL CONTRACTORS INC
8733 N MAGNOLIA AVE 112
SANTEE, CA 92071
Fee Description Qtv 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 -
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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 License No. ( �O 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
❑ 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 Cade, 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
le 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:http�//www.leclin-fQ.m.ciov/cglaw.htmi.
permit is issued.My rw�'orr'kers'compensation insurance carrier and policy number are:
Carrier E/zt'23'f Property Owner or Authorized Agent Date
Expires 1011-1�1 11 Policy# -1(06o 0 i 0
W 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 stale 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 5 /G� 2�/ s
workers' compensation laws of California, and agree that If I should become
subject to the workers'compensation provisions of Section 3700 of the Labor prop ner o Authorized Agent Date
Code,I she forthwith comply with those provisions. �y
F J City Business License# c)3746
Date; ✓ I Q iS Applicant;
WARNING: FAILURE TO S/ECIIF& 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 A HAZARDOUS MATERIAL OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES W0 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 DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address 'ZNO 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 ❑YES 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, 2VO 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 1 HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or /�VES 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 '%77T UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZAADOUS MATERIAL I';EPORTING.
compensation,will do( )all of or( ) porting of the work, and the structure is PROPERTY QWNER OR AUT RIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
City of Menifee
pA.,11dipg & Safety Dept.
DATE 11AV I q Nis PERMIT/PLAN CHECK NUMBER N1'Ct5-0 jv-;F5x
TYPE: " COMMERCIAL Cx RESIDENTIAL 0 MULTI-FAMILY C% MOBILE HOME % POOL/SPA 0 SIGN
ADDITION O ALTERATION %DEMOLITION 9ELECTRICAL C MECHANICAL
R oofti r G
0 NEW O PLUMBING RE-ROOF-NUMBER OFSQUARES
DESCRIPTION OF WORK EXISTING ELECTRICAL PANEL UPGRADE TO 12.5 AMPS
PROJECTADDRESS 2-1017- Cvy uS Wa j 5 Lp
ASSESSOR'S PARCEL NUMBER 3"� ;4:5 LOT TRACT
OWNER NAME Bill 1 I D wa
ADDRESS
PHONE 951' (p--3zQ3 EMAIL
APPLICANT NAME SMITH ELECTRICAL CONTRACTORS, INC
ADDRESS 206 GREENFIELD DR#G,EL CAJON,CA 92020
PHONE 619-758-9829 X101 EMAIL permitupdates@smithelectricsd.com
CONTRACTOR'S NAME SMITH ELECTRICAL CONTRACTORS,INC OWNER BUILDER? O YES C NO
BUSINESS NAME SAME
ADDRESS SAME AS ABOVE
PHONE SAME EMAIL SAME
CONTRACTOR'S STATE LIC NUMBER 871200 LICENSE CLASSIFICATION C-10
VALUATION$ 1400.00 SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE 5-19-7-015
DEPARTMENT DISTRIBUTION CITYQnELM I SI L ENSENUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN10D SMIP V �
INVOICE /V PAID AMOUNT
AMOUNT 'CASH %CHECK# %CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CASH %CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0 YES <% NO DL NUMBER NOTARIZED LETTER O YES NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinerifee.us Inspection Request Line 951-246-6213