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PMT15-02919 1 City of Menifee Permit No.: PMT16-02919 29714 HAUN RD. Type: Residential Electrical CCIE../ MENIFEE, CA 92586 ewromxrx s.Mima" MENIFEE Date Issued: 09/21/2015 i �I PERMIT 1 Site Address: 27210 CAPILANO DR, MENIFEE, CA Parcel Number: 336-062-019 1, 92586 Construction Cost: $2,500.00 Existing Use: Proposed Use: Description of MAIN SERVICE PANEL UPGRADE TO 200AMPS FOR SOLAR PERMIT PMT15-02918 Work: Owner Contractor MARY MONTGOMERY T A K ELECTRIC INC 27210 CAPILANO DR 1654ILLINOIS AVENUE STE 18 MENIFEE, CA 92586 PERRIS, CA 92571 Applicant Phone: 9519703150 NADIA CONTRERAS License Number: 947912 T A K ELECTRIC INC 1654ILLINOIS AVENUE STE 18 PERRIS, CA 92571 Fee Description - Qtl Amount f$1 Building Permit Issuance 1 27.00 x..r mw.w.a General Plan Maintenance Fee-Electrical 1 5.80 $149.80 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 3 City Of Menifee I LICENSED DECLARATION ❑ I am exempt from licensure under the Contractors'Slate License Law for the following reason: I hereby affirm under penalty or perjury that I am licensed under provisions of Chapter 9 (commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence In Professions Code and my license is in full force and effect. which I must have resided for at least one year prior to completion of License Clas O License No. 4/Z improvements covered b this permit, I cannot legally s Y P ell a structure that� Y I have Expires Signature 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 WORKERS'COMPENSATI ON DECLARATION Business and Professions Code,is available upon request when this application is submitted or at the following Web site: ❑ I hereby affirm under penalty of perjury one the following declarations: http://www leglnfo ca oov/calaw html. I have and will maintain a certificate of consentt of self-insure for workers' compensation,issued by the Director of Industrial Relatoarovided for by Date Section 3700 of the Labor Code, for the performance of work for which this permit is issued. Property Owner or Authorized Agent Policy# y/By my Signature below, I certify to each of the following: I am the property Xi I have and will maintain workers' compensation insurance, as required by 6wner or authorized to act on the property owner's behalf. I have read this - section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comply permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to building r��l e construction. I authorize representatives of this city or county to enter the above- Carrier fV'n`(L{� J�/(r/.i,1L21/it/ identified rep/efp" for�the inspection purposes. Policy#CW(- �_) �'�(_5bxpires5l �/ `'-i' ��__Date �2(/•�S Property'Owner or Authorized Agent (This section need not be completed if the permit is for City Business License# one-hundred dollars($100)or less) Y I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION s all not employ any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a workers'compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the subject to the workers'compensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide? Code,I shall forthwith comply with those provisions, EYES ),NO Applican Will the intended use of the building by the applicant or future building occupant require a permit for the construction or modification from South WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES fvt NO CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS �`" ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school? LABOR CODE, INTEREST,AND ATTORNEYS FEES El YES KNO CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist. I understand my requirements under the State of agency for the performance of the work which this permit is issued (Section California Health&Safety Code,Section 25505 and 25534 concerning 3097 Civil Code) hazardous material reporting. OWNER BUILDER DECLARATIONS /6YE � I hereby affirm under penally of perjury that I am exempt from the Contractor's �� 2" " 4 � Date'Z'G'r '/S License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER ORAUTHORIZED AGENT next to the applicable items) (Section 7031.5. Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION REPAIR AND PAINTING (RRP) 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 The EPA Renovation, Repair and Painting(RRP)Rule requires contractors provisions of the Contractor's State License Law (Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978 Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their a civil penalty of not more than ($500).) employees.For more information about EPA's Renovation Program visit: www ape gov/lead or contact the National Lead Information Center at El I, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(5323). compensation, will do ( )all of or ( ) porting of the work, and the structure is 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 ❑An EPA Lead-Safe Certified Renovator will be responsible for this project who, through employees' or personal effort, builds or improves the property, provided that the Improvements are not intended or offered for sale, If,however, Certified Firm Name: 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 Finn Certification No.: purpose of sale). ❑ I, as owner of the property an exclusively contracting with licensed ❑ No EPA Lead-Safe Certified Firm is required for this project because: contractors to construct the project (Section 7044, Business and Professions Code:The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who contracts for the projects with a licensed contractors)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the REP Acknowledgement. BUILDING : APPLICATION Menifee r 1Q p DATE (•�S PERMIT/PLAN CHECK NUMBER 00� {� l TYPE: C' COMMERCIAL ;YRESIDENTIAL t:% MULTI-FAMILY C' MOBILE HOME :'} POOL/SPA SIGN SUBTYPE: ADDITION 0 ALTERATION 0, DEMOLITION C) ELECTRICAL <; MECHANICAL 0 NEW PLUMBING 0 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK PROJECTADDRESS 5W G*• CX ASSESSOR'S PARCEL NUMBER -V '0 1 LOT 5 '] TRACT �40a- OWNER NAME ADDRESS g27G\ lV PHONE / ).2 °�2 EMAIL APPLICANT NAME a �a ADDRESS Jr' (�e �! �i �• (�' C12.S� PHONE SI / l EMAIL CONTRACTOR'S NAME 74,21 , OWNER BUILDER? C YES C;1l6 BUSINESS NAME ADDRESS��66�� PHONE �•7 ,Z(\ ZaG • 3�05� EMAIL /` CONTRACTOR'S STATE LIC NUMBER Z LICENSE CLASSIFICATION Gf l* e VALUATION$ Z, SQO SO FT L SO FT APPLICANT'S SIGNATURE DATE OTYSTAFFUSEONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN p SMIP INVOICE AMOUNT , . PAIDAMOUNT ,)CASH OCHECK# Ci CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT 0CASH .%CHECK# C CREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER C; 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