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
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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.