PMT15-01765 City of Menifee Permit No.: PMT15-01765
29714 HAUN RD.
Oq�6�—A> MENIFEE, CA 92586 Type: Residential Electrical
MENIFEE Date Issued: 0 612 512 01 5
PERMIT
Site Address: 28940 SNEAD DR, MENIFEE, CA 92586 Parcel Number: 337-391-013
Construction Cost: $1,400.00
Existing Use: Proposed Use:
Description of EXISTING ELECTGRICAL PANEL UPGRADE TO 200AMPS
Work:
Owner Contractor
SUSAN BROWN SMITH ELECTRICAL CONTRACTORS INC
28940 SNEAD DR 8733 N MAGNOLIA AVE 112
MENIFEE, CA 92586 SANTEE, CA 92071
Applicant Phone:6197589829
EMILY FORSTER License Number: 871200
SMITH ELECTRICAL CONTRACTORS INC
8733 N MAGNOLIA AVE 112
SANTEE, CA 92071
Fee Description C3yt Amount($)
Building Permit Issuance 1 27.00
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 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_Templale.rpt Page 1 of 1
City Of Menifee
a
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 III
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 U License No. 0 who builds or improves thereon, and who contracts for the projects with a
Expires I 1 Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ lam exempt from licensure under the Co^'r.ators'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 ackn .aierl than, exce^' ' cantonal residence in
compensation, issued by the Director of Industrial Relations as provided for by which I must have „aed for at least one year prior co completion of
Section 3700 of the Labor Code, for the performance of work for which this _ 4
Improvements -,,,ere,' by mis permit, I cannot legally sell a structue ,.
permit is issued.
# hill"' �o o� uuilding if it has not been constructed in its entirely by Idenseu
Policy contractors. I understand that a copy of the applicable law, Section 7044 of the
7�7 I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
section 37DO of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http://www.leciinfo.ca.gov/calaw,htmi. 1.
permit is issued.My Iw�,orketrs''coom,pensati+on insurance carrier and policy number are:
Carrier Eyeres IVLt110i1Gt1 Property caner or Authorized Agent Date
ns . La .
Expires 10/23�I S Policy#7hOD01D14D131
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 slate 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 identiifieed`pr�oip/e�rty�f�o/r�tthh�e i s coon 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 -
Code,I shall forthwith comply with those provisions. Property Ow er or Au orized Agent 'may q�yC,Date
4'? `JV j 9 City Business License# ® -746 f 7
Date; t��z5-/(5 Applicant; �i'YI yC_j - -
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, ❑YES 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 gNO 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 'WO 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 AYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable items)(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, ENO 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 I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or W"ES 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($500).) CODE, SECTION 25505, 25533 AND 25534 CONCERNING
❑ 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING.
compensation, will do ( )all of or ( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044, Business and Professions Code; .
The Contractor's State License Law does not apply to an owner of a property
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale. If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
chec(L afpbca-fibn
DATE D12, �I S PERMIT/PLAN CHECK NUMBER M7��7� oI�I lay
TYPE: nCOMMERCIAL Ox RESIDENTIAL ":) MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA :% SIGN
SUBTYPE: "ADDITION O ALTERATION C DEMOLITION Ox ELECFRICAL C MECHANICAL
O NEW `O PLUMBING 01RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK EXISTING ELECTRICAL PANEL UPGRADE TO 200 AMPS
PROJECTADDRESS Z p ,4V Sneold Dr. aMe 1 9213F(o Y
ASSESSOR'S PARCEL NUMBER ")'51— ) L1-0 03 LOT i a� TRACT � 1
OWNERNAME YUSCIn RnWn
ADDRESS '2 -4 �nead Dr.
ens o
e 09- ZS /L
PHONE /S� - � I (01 S EMAIL i
APPLICANT NAME SMITH ELECTRICAL CONTRACTORS,INC
ADDRESS 206 GREENFIELD DR#G,EL CAJON,CA 92020
PHONE 619-758-9829 X101 EMAIL permitupdates@smithelectricsd.com
CONTRACTOR'S NAME SMITH ELECTRICAL CONTRACTORS, INC OWNER BUILDER? 0 YES ONO
BUSINESS NAME SAME
ADDRESS SAME AS ABOVE
PHONE SAME EMAIL SAME
CONTRACTOR'S STATE LIC NUMBER 871200 LICENSE CLASSIFICATION C-10
VALUATION$ 1400.00 SO FT L SO FT
APPLICANT'S SIGNATURE DATE S
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS UgNSS NUMBER
BUILDING PLANNING ENGINEERING FIRE GREENtog $MIP ?) Fl(ori(-lj.
INVOICE E� PAID AMOUNT
AMOUNT -CASH '•..''CHECK 01CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH %CHECK# "CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED Q YES O NO DL NUMBER NOTARIZED LETTER O YES v% 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