PMT15-01937 City of Menifee Permit No.: PMT15-01937
29714 HAUN RD.MENIFEE, CA 92586 Type: Residential Electrical
MENIFEE Date Issued: 07/09/2015
PERMIT
Site Address: 29810 MORNING BREEZE DR, MENIFEE, Parcel Number: 339-391-011
CA 92584 Construction Cost: $1,400.00
Existing Use: Proposed Use:
Description of MAIN PANEL UPGRADE 200A
Work:
Owner Contractor
BARBARA COLLINS SMITH ELECTRICAL CONTRACTORS INC
29810 MORNING BREEZE DRIVE 8733 N MAGNOLIA AVE 112
MENIFEE, CA 92584 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 City 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 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_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�"10_License No, d0 who builds or improves thereon, and who contracts for the projects with a
Expires A! /1/ O Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ 1 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 in
Section 3 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
of
permit is issued. built as an owner-building if it has not been. constructed ihits entirety.by licensed
Policy# contractors. I understand that a copy of the applicable law, Section 7044 of the
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:bttp:l/www.leciinfo.ca,gov/calaw.html.
permit is Issued,My workers'compensation insurance carrier and policy number are:
Carrier C ferc, 601,0(w �dl j CO , - Property Owner or Aut ooze Agent
"I N Date
Expires Policy#7&000040131
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-
0 1 certify that in the performance of the work for which this permit is issued, I identified property for the in pection 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 O ner or Kutherized Agent Date
Date; ! /� Applicant; C G.YIi' City Business License#
^7�"1—�S
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 �YN0 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 war](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 AYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
O FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address 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 ❑YES 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, 0 SCHOOL7
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 )s 9ES 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 WNER OR UTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's Slate License Law does not apply^o 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).
DATE PERMIT/PLAN CHECK NUMBER — 01g3
TYPE: " COMMERCIAL CX RESIDENTIAL L MULTI-FAMILY 0 MOBILE HOME O POOLI SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION C DEMOLITION `I ELECTRICAL O MECHANICAL
O NEW " PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK EXISTING ELECTRICAL PANEL UPGRADE TO 20O AMPS
iI
PROJECT ADDRESS 2/��1 0p 1 0 M 01'rlII Q B reei�P_ Dr, WniyW S F*
I y Of nifee !
ASSESSOR'S PARCEL NUMBER p 1 'c)k\ LOT TRACT Building & Safety Dept. !
OWNER NAME Bo('_bara OI JUL 2015
ADDRESS 2gF10 P40minq StfeH Or qz5
ece ved I
PHONE q51- 301 - 5cl ' EMAIL 1
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 gNO
BUSINESS NAME SAME
ADDRESS SAME AS ABOVE
1
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
DEPARTMENT DISTRIBUTION C"OF MENIFEE BUSINESS LICENSE NUMBER
i
BUILDING PIANNING ENGINEERING FIRE GREEN , SMIP
INVOICE I PAID AMOUNT
NT
AMOUNT L — O CASH -,CHECK# CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT O CASH "'CHECK# C•CREDITCARD VISA/MC
OWNER BUILDER VERIFIED `-YES NO DLNUMBER NOTARIZED LETTER ^ YES NO
City of Menifee Building&Safety Department 29714 Naun Rd, Menifee, C4 92586951-572-6777
www.citvCfinenifee.us inspection Request Line 951-245-5213
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