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PMT15-03525 City of Menifee Permit No.: PMT15-03525 29714 HAUN RD. Type: Residential Electrical <A-CCELjA-> MENIFEE, CA 92586 c"'""-"`Wt.— MENIFEE Date Issued: 11110/2015 PERMIT Site Address: 29276 ANNANDALE DR, MENIFEE, CA Parcel Number: 338-291-021 92586 Construction Cost: $800.00 Existing Use: Proposed Use: Description of INSTALL 4 CAN LIGHTS IN KITCHEN ON EXISTING SWITCH, MOVE WATER BOX FOR FRIDGE 18" Work: Owner Contractor LEONARD MELSBACH A A A RESTORATION INC 29276 ANNANDALE ROAD 29850 2ND STREET MENIFEE,CA 92586 LAKE ELSINORE, CA 92532-2420 Applicant Phone: 9514715828 JOSH BRUNETTE License Number..834839 A A A RESTORATION INC 29850 2ND STREET LAKE ELSINORE,CA Fee Description Qtv Amount ISI Receptacle, Switch, Outlet&Fixture 4 131.00 Plumbing Fixtures and Vents,fixtures 1 116.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Electrical 1 6.55 $281.55 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_Pennit_Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ I am 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 G License Ng. 3Hl31 improvements covered by this permit, I cannot legally sell a structure that I have Expires 4- 1-I IP Signature� built as an owner-building if it has not been constructed in its entirety by licensed contractors. 1 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 I hereby affirm under penalty of perjury one the following declarations: htto://www.leainfo.ca.cov/calawhtml. have and will maintain a certificate of consentt of self-insure for workers' compensation,issued by the Director of Industrial Relations as provided for by Date Section 3700 of the Labor Cade, for the performance of work for which this permit is issued. Property Owner orAulhodzed 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 owners 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 construction.I authorize representatives of this city or county to enter the above- Carrier finnaLSwic identif�ie,Qyr�(peep,Y for the inspection purposes. Policy# CST ,S606"LfZ- Expires —31 I� =RAY yz Date+11.17 Propert(,'Owner orAuthorized Agent (This section need not be completed if the permit is for City 37(s 3% one-hundred dollars($100)or less) ty Business License# 0 ❑ I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION shall not emolov any persons in any manner so as to become subject to the WIII 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 complywith those provisions. ❑YES q NO Applicant; rllt fj'l' Date; 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 SLNO CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, WIII 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 DYES SIND 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 Stale of agency for the performance of the work which this permit is issued (Section California Health&Safety Cade,Section 25505 and 25534 concerning 3097 Civil Code) hazardous material reporting. OWNER BUILDER DECLARATIONS DYES 9 NO I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT next to the applicable item(s)(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(RRP1 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(S500).) employees.For more information about EPA's Renovation Program visit: www.epa.gov/lead or contact the National Lead Information Center at ❑ 1, as owner of the property, or my employees with wages as their sole 1-800424-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 Stale 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 rra1!EPA Lead-Safe Certified Firm is required for this project because: contractors to construct the project(Section 7044, Business and Professions ,f Code:The Contractor's License Law does not apply to an owner of a property T f D pgr7t' — du,r)-}� T-dp;yr All t1 1 - who builds or improves thereon, and who contracts for the projects with a 74 ffQ%rE s fC (A553 Thorn 16 ya-?. 4p, & SAFETY PERMIT/PLAN CHECK APPLICATION _J Menifee DATE I'ItT l5 PERMIT/PLAN CHECK NUMBER n_0wz5L5 TYPE: COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOB�ILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION --'ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK ADD 64n lj HTS 13n PROJECTADDRESS 2 2J6 n11 1L^ 'Tlly-E gArl G)fi ASSESSOR'S PARCEL NUMBER �� rxQ1—��`, LOT TRACT OWNER NAME R., City Of Menifee ADDRESS �.q PHONE y�� 7 1 3 3-N EMAIL ��pp APPLICANT NAME � &tX Recelvgd ADDRESS PHONE EMAIL CONTRACTOR'S NAME K1/14_ yhLA4,\Jp OWNER BUILDER? O YES IND BUSINESS NAME j ADDRESS zgOO 2N ST `t4w.6 eL In Y£ PHONE q�51 -5q- 0fi7i� EMAIL CONTRACTOR'S STATE LIC NUMBER S3q t' l LICENSE CLASSIFICATION VALUATION $ o SQ FT L SO,FT APPLICANT'S SIGNATURE DATE i I' I D -I b G, /I DEPARTMENT DISTRIBUTION "CITYNIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE fF PAIDAMOUNT u,NT OCASH CHECK# CiCREDITCARD VISA/MC LAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VIWMC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building &Sofety Deportment 29714 Huun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 D - N City of Mentfee o Building & Safety D Fit =n 3 moo. � NOV a 1 0 201 = = f II ^� U - G Receive LLJ LL \\,x !, 24.D HW = It N CIO .L a —N � -'- r ' m J i J aye-svodoef3 w - � . CD U - -- ZL6£M17Z 90£LZAA 80£LZAA J C _ r J•r MZ2LZd3a - , r l r j I E o 1211.1 s. 3 1 CITY OF M IF — --- — BUILDING AFETY DEPARTM co PLAN AP U coCID N REVIE AL 011� vAf E co j 'Approval of these plans shall not be construed to be a permit for,or an v— approval of,any violation of any provisions of the federal,state or city regulations and ordinances. This set of approved plans must be kept on the jobsite until completion.