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PMT15-03270 City of Menifee Permit No.: PMT16-03270 29714 HAUN RD. Type: Residential Electrical �CCr LA? MENIFEE, CA 92586 MENIFEE Date Issued: 10/21/2015 PERMIT Site Address: 29776 BUENA TIERRA RD, MENIFEE, CA Parcel Number: 336-201-019 92586 Construction Cost: $500.00 Existing Use: Proposed Use: Description of SAFETY INSPECTION Work: Owner Contractor PAULSOUCEY 29776 BUENA TIERRA MENIFEE,CA 92584 Applicant License Number: PAULSOUCEY 29776 BUENA TIERRA MENIFEE, CA 92584 Phone: 9583338258 Fee Description Qt( Amount I$ Meter Reset 1 116.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 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_Pemnit Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'State License Law for the I hereby affirm under penalty or perjury that I am licensed under provisions of following reason: 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 Class License No. improvements covered by this permit, I cannot legally sell a structure that 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'COMPENSATION 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 t the following for workers; http:/lwww.leginfc.ca.cov/ralaw.html. I have and will maintain a certificate of consent of self-insure for workers' compensation,issued by the Director of Industrial Relations as provided 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# ❑ By my Signature below, I certify to each of the following: I am the property ❑ 1 have and will maintain workers' compensation insurance, as required by owner 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 a information I have provided is correct. I agree to comply permit is issued.My workers'compensation insurance carrier and policy number are: with all applilt�city and county ordin es and state laws relating to building censtructi nyuthorize representafiv s o it ty or county to enter the above- Carrier identifier)pr party f r the inspection p / i Date / 6 —22 —�f Policy# Expires Prope Owner or Authorize 9 ent (This section need not be completed if the permit is for City Business License# one-hundred dollars($100)or less) © I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION shall 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 C��lifor is, and agree that if should become ixture containing a hazardous material equal to or greater that the subject to the worke compen�at rovisions of Section 3700 of the Labor Code,I shZfoitrhscompi�t t se provisions. mounts specified on'the Hazardous Materials Information Guide? NO Applicant Date; ill the intended nded use of the building by the applicant or future building /T� 21- S� - ccupant require a permit for the construction or modification from South WARNING: F URE TO SECURE WORKERS' oast Air Quality Management District(SCAQMD)?See permitting checklist COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL or guidelines SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES ❑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 school? LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES ❑NO CONSTRUCTION LENDING AGENCY I have read the H�ous Material Information Guide and the SCAQMD I hereby affirm that under the penalty of perjury there is a construction lending permitting chec I nderstand my requirements under the State of agency for the performance of the work which this permit is issued (Section California Hee��MmIt &S fety Cod ection 25505 and 25534 concerning 3097 Civil Code) hazardo �(nateria deporting OWNER BUILDER DECLARATIONS IDY ❑NO ,fin ` 2/ 1 hereby affirm under penalty of perjury that I am exempt from the Contractor's Date I� License Law for the reason(s)indicated below by the checkmark(s)I have placed PROP TY OWNER OR AUTHORIZED AGENT next to the applicable item(s)(Section 7031.5. Business and Professions Code: EPA RENOVATION.REPAIR AND PAINTING(RRP) Any city or county that requires a permit to construct, alter, improve, demolish, 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 Ilcensure 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.epa.gov/lead or contact the National Lead Information Center at ❑ 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 Contractors 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 purpose of sale). Firm Certification No.: ❑ 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 contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP Acknowledqement. CPERMIT/PLAN CHECK APPLICATION - -- - - 'Men'fee DATE I C' +— 1 S PERMIT/PLAN CHECK NUMBER tiL 5• O Z TYPE: ❑COMMERCIAL ❑RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN SUBTYPE: ❑ADDITION []ALTERATION []DEMOLITION ❑ELECTRICAL [-]MECHANICAL ❑NEW [-]PLUMBING ❑IpRE-ROOF-NUUMBEROF SQUARES DESCRIPTION OF WORK L kC k- Dr k > O 6" ,Z t r=JC� If,t c rJ 4v 141) ;M-e. PROJECTADDRESS 9 p Bu.,''k E ASSESSOR'S PARCEL NUMBER 3�• Zo j- Q 19 L/OTT 2? 5 TRACT /Z 5(v - PROPERTY OWN ER'SNAME F GU.II L ( (..f:D / C/ 1'�i[(Pp55 c. ADDRESS Z- -) 1,1 ( .1 el I % e ✓ ��I/) r" T PHONE (ISO ,33- 8) s-u EMAIL Q 7-.5 ?(D APPLICANT NAME J/ r _ p LL `/ ADDRESS (�� 7 6 so 4 I et f i S�, 6 PHONE ! �5 �� 3 S y-�18 9� EMAIL S L) u f Q // �a CONTRACTOR'S NAME OWNER BUILDER? ❑YES❑NO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ SO FT / L SO FT APPLICANT'S SIGNATURE ✓ DATE _ DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O 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