The URL can be used to link to this page

PMT15-03283 City of Menifee Permit No.: PMT15-03283 29714 HAUN RD. �CCEL/? MENIFEE, CA 92586 Type: Residential Electrical MENIFEE Date Issued: 10I22I2015 PERMIT Site Address: 26622 JAELENE ST,MENIFEE,CA 92586 Parcel Number: 335-282-016 Construction Cost: $500.00 Existing Use: Proposed Use: Description of ELECTRICAL PANEL UPGRADE 200AMP FOR SOLAR PERMIT PMT15-02780 Work: Owner Contractor JOSEPH MARTZ VISION INSTALLATION 26622 JAELENE ST 5255 N EDGEWOOD DR MENIFEE,CA 92584 PROVO, UT 84604 Applicant Phone:8887817074 KELLY BAKER License Number:853582 VISION INSTALLATION 5255 N EDGEWOOD DR PROVO,CA 84604 Fee Description Oty Amount(Sl Receptacle,Switch, Outlet&Fixture 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 building operations being carried an 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_Pernit 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 fore and effect. Code:The Contractor's License Law does not apply to an owner of a property License Class —k 0 Licens No. Z— who builds or improves thereon, and who contracts for the projects with a Expires` Lk I f2 Signatu Z_ licensed contractor(s)pursuant to the Contractors Stale License Law). WORKERS'COMPENSATION DECLARATION ❑ lam 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 3700 of the Labor Code, for the performance of work for which this permit is issued. improvements covered by this permit, I cannot legally sell a structure that I have Policy# built as an owner-building ff it has not been constructed in Its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the OEI� 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:http:/Iwww.leainfo.ca.goy/calaw.html. permit is issued.My worke�mpen ation insurance carder and policy number are: Carder Property Owner or Authorized gent Date Expires Policy#�' 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- qyrcertify that in the performance of the work for which this permit is issued,I ident(fed profpaHy-f r the' pection purposes. shall not employ any persons in any manner so as to become subject to ther— workers'compensation laws of Calfomia, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor p 0 r or Authorized Agent Date Code,I shall forthwith comply with those pro visio 1 / City Business License# Date; ID I//- ) AppII ant; WARNING: FAILURE TO SE URE 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, AYES OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE �,'go� MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES Y 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 ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address XJ NO 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. 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 AYES 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 � 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 AEPOPING. compensation,will do( )all of or( )porting of the work, and the structure is PROPER OWN AU ORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; o 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). & SAFETY PERMIT/PLAN CHECK APPLICATION - Menifee cc 22 DATE j PERMIT/PLAN CHECK NUMBER I7' 'J0-) TYPE: O COMMERCIAL :; RESIDENTIAL O MULTI-FAMILY :> MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION C DEMOLITION O ELECTRICAL O MECHANICAL C: NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK `` PROJECT ADDRESS ASSESSOR'S PARCEL NUMBER LOT TRACT PROPERTY OWNER'S NAME ADDRESS C q PHONE( 5I -4(0 (-lp ► Cn EMAIL APPLICANT NAME ADDRESS PHONE / ( EMAIL CONTRACTOR'S NAME GJU (.CAI( OWNER BUILDER? O YES C NO BUSINESS NAME ADDRESS (J PHONE EMAIL ha U CONTRACTOR'S STATE LIC NUMBER 2 LICENSE CLASSIFICATION p O VALUATION $ SO FT L SO FT �7 APPLICANT'S SIGNATU DATE O L I DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP INVOICE C' PAIDAMOUNT C C -� AMOUNT I b� CASH CHECK# <.CREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT CCASH O CHECK# <%CREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER C YES C NO City of Menifee Building&Safety Department29714 Houn Rd. Menifee, CA 92586951-672-6777 www.cityofinenifee.usInspection Request Line 951-246-6213