PMT15-01672 a
3
d,
City of Menifee Permit No.: PMT16-01672
�. 29714 HAUN RD.
CCL.7Y MENIFEE, CA 92586 Type: Residential Electrical
MENIFEE Date Issued: 0 7/0112 01 5 g
1
PERMIT
Site Address: 26569 GOODRICH DR, MENIFEE, CA Parcel Number: 331-492-007
92586 Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of MAIN PANEL UPGRADE 125A
Work:
Owner Contractor
GARY SIMS DISTINCTIVE HOME IMPROVEMENTS INC
26569 GOODRICH DRIVE 9235 TRADE PLACE SUITE G
MENIFEE, CA 92585 SAN DIEGO, CA 92126
Applicant Phone: 6198578388
BRANDON KRAFT License Number: 807753
DISTINCTIVE HOME IMPROVEMENTS INC
9235 TRADE PLACE SUITE G
SAN DIEGO, CA 92126
Fee Description QQb Amount l$1
Se des-.S itc b ar s o tro:Ce a e S ti 16`0 -
Building Permit Issuance 1 27.00
EENa E- 0
$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 building 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_Bidg 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 C e an my/L,�.ense is in full force and ff Code:The Contractor's License Law does not apply to an owner of a property
License Cla s �-license N 7� who builds or improves thereon, and who contracts for the projects with a
Expires Signatu licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARA ION
❑ ]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 3710 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 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:htipi/www,leainfg.m.qgv/calaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
c 1 Property Owner or Authorized Agent
Carrier Date
Expires i Policy
# ,G�,'Y
Name of Agent ' rrN-aihone# �R pl �D4 p�I ❑ By my Signature below, 1 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-
El I certify that in the performance of the work for which this permit is issued,I identified pippeff) for the inspection purposes.
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 p rt Owner o Aut prize gent Da
Code,I shall forthwith comply with those provisio s. 2
Applican
Date; I — City Business License#
WARNING: FAILURE TO SEC ORKERS' 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, ❑YES 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 `7110 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
Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
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 State License Law (Chapter9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or \_AES 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($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL I}l
compensation, will do ( )all of or( )porting of the work, and the structure is PROPERTY O E R AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE 0 6/1 612 0 1 5 PERMIT/PLAN CHECK NUMBER
TYPE: [—]COMMERCIAL 0 RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑ POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION [Z]ELECTRICAL ❑MECHANICAL
❑NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Installation of new 125AMP Service Panel
PROJECT ADDRESS 26569 Goodrich dr, Romoland,CA 92585
ASSESSOR'S PARCEL NUMBER 331-492-007 LOT TRACT
OWNER NAME Gary Sims
ADDRESS 26569 Goodrich dr, Romoland, CA 92585
PHONE (760)310-8513 EMAIL
APPLICANT NAME Pete Tsambasis
ADDRESS 9159 Chesapeake dr,San Diego,CA 92123
PHONE (858)212-9753 EMAIL petet@suncoastsd.com
CONTRACTOR'S NAME BRANDON LAVERN KRAFT OWNER BUILDER? ❑YES❑NO
BUSINESS NAME DISTINCTIVE HOME IMPROVEMENTS INC
ADDRESS 9235 Trade PI Ste G,San Diego, CA 92126
PHONE (619)857-8388 EMAIL petet@suncoastsd.com
CONTRACTOR'S STATE LIC NUMBER 807753 LICENSE CLASSIFICATION C-10
VALUATION$ $ 1,500.00 SO FT 1954 L SO FT 7840
APPLICANT'S SIGNATURE Yde 96am aow DATE 6/16/15
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN _ SMIP
INVOICE AMOUNT
PAID
AMOUNT I� OCASH 0 CHECK It <%CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK# 'CREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0 YES Q NO OIL 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