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PMT15-01577 { I City of Menifee Permit No.: PMT15-01577 29714 HAUN RD. �CCCJE MENIFEE, CA 92586 Type: Commercial Electrical i MENIFEE Date Issued: 0 6/1 012 01 5 i PERMIT Site Address: 27192 SUN CITY BLVD, MENIFEE, CA Parcel Number: 337-310-034 92586 Construction Cost: $10,000.00 i Existing Use: Proposed Use: Description of REPLACE METER SOCKET&TEST BLOCKS, REPLACE 200AMP Work: Owner Contractor DAVID IM CENTRAL MECHANICAL 27192 SUN CITY BLVD P 0 BOX 611 MENIFEE, CA 92586 SUN CITY, CA 92586 Applicant Phone: 9516574292 STEVE ROULETTE License Number: 774925 CENTRAL MECHANICAL P 0 BOX 611 SUN CITY, CA 92586 Fee Description Qtt Amount 1$I �Se lces�SwltChb6ard��Cof�tYofCenters&Pater-efs � `TT �,T •.1`��`t��t ��'�s' �18 Meter Reset 1 % 116.00 -.3e�.�:c�nmixx..'.ev+kLx_---�:....�,.r.,��:v.,`Goa'.�,,.,.a>...5,., ma•:.�s,.ss �,.Y�""+.�si::',.�3�.nac' .,::. GREEN FEE 1 1.00 $327.00 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(,l-Z- 3 J License No. 2 who builds or improves thereon, and who contracts for the projects with a Expires 2.'ZY-Z01G SignatureC 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 ❑ 1 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 leclinfo ca govicalaw.html. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier Property Owner or Authorized Agent Date Expires 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 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- ,I certify that in the performance of the work for which this permit is issued,I identified pproperty for the insp ction Our uses. 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 _ / •,lroperty Owner or Authorized Agent Date Code,II shall +forthwith comply with those provisions. T� e _` �te; V! -Iy- I Applicant; City Business License# C4 X�`(b r 84- 1 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL HAZARDOUS MATERIAL DECLARATION 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, 1LvES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR DAMAGES AS PROVIDED FOR IN SECTION 3701 OF THE 'N 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 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 Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT ❑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 OYES 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, NNO SCH000 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 Stale License Law (Chapter 9 (commending with I HAVE READ THE HAZARDOUS MATERIAL Section 7000)of Division 3 of the Business and Professions Code)or that he or y�yES INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from licensure and the basis for the alleged exemption. Any rM 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 ❑ 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL f EPOR1 ING. compensation, will ( )all of or( ) porting of the work, and the structure is PROPERT AU ENT 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 1 Menifee DATE PERMIT/PLAN CHECK NUMBER I�p� ✓� TYPE: ` COMMERCIAL O RESIDENTIAL C% MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA c> SIGN SUBTYPE: "'ADDITION 0ALTERATION 0 DEMOLITION ; ELECTRICAL " MECHANICAL O NEEW ',"' PLUMBING C RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK { e- f � mL1 G�/' SOL�C�� •'( C lixi S PROJECTADDRESS 2� 1 9 2 SOY) (-'ri,,//��j U �, t�� 2� SC), ASSESSOR'S PARCEL NUMBER 3'I-1 - 3lo-y;3qLOT TRACT OWNERNAME 0 y', 2 T ADDRESS -1 1 /Z S" L-1T"I lv('— siry) C' 6k 9ZSpC1 PHONE 3-&I ' (p)C1- IH'ZO EMAIL APPLICANT NAME (�Sf IL I cer f. ADDRESS Sj Ci�- Z�D PHONE 4 Zq�. EMAIL t1 VC J 3 V1 vw, ,U CONTRACTOR'S NAME STCjC_ e-GJ 1C -z- OWNER BUILDER? ;;YES 0 BUSINESS NAME f fA I M ' " A,, c,C4 ADDRESS .d, l30 1I J( ) 6I ! CA, ( Z�� PHONE S I- 1p ��- H 2(9 2 EMAIL J V C14 3 I , (J vyl CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION Ila ZO 3% VALUATION $ �� SO FT �L"'�C� L SO FT r� APPLICANT'S SIGNATURE DATE `� J !�,Ty STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENI EE BUSINESS LICENyE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP 84 INVOICE PAID AMOUNT AMOUNT iCASH t CHECK# :i CREDIT CARD VISA/MC POWNER N CHECK FEES PAID AMOUNT C%CASH C:'CHECK4 CREDIT CARD VISA/MC UILDER VERIFIED Q YES " NO DL NUMBER NOTARIZED LETTER ) YES 0 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