PMT15-03718 City of Menifee Permit No.: PMT15-03718
29714 HAUN RD. Type: Residential Electrical
�CCF1/-. MENIFEE,CA 92586
MENIFEE Date Issued:
12/O1I2015
PERMIT
Site Address: 28590 MAPLEWOOD DR, MENIFEE, CA Parcel Number: 372-062-003
92584 Construction Cost: $600.00
Existing Use: Proposed Use:
Description of DERATE MAIN PANEL TO 175A
Work:
Owner Contractor
LAWRENCE MCCUISTION SOLCIUS LLC
28590 MAPLEWOOD DRIVE 1145 SOUTH 800 EAST#201
MENIFEE, CA 92584 OREM, UT 84097
Applicant Phone:8018994540
CHRISTIAN OSORIO License Number:976336
SOLCIUS LLC
12155 MAGNOLIA AVE
RIVERSIDE,CA 92503
Phone:8443572258
Fee Descriotion C1yt Amount tSl
Services, Switchboards, Control Centers&Panels 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 carded 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_Bidg_Permit Terrplate.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 force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class Y
ss G—10 License No. ?7�336 who builds or improves thereon, and who contracts for the projects with a
Expires'/ 30 L- Stgnature ( ' i licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am 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:
1 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 improvements covered by this permit.I cannot legally sell a structure that I have
permit is Issued. built as an owner-building if It has not been constructed in its entirety by licensed
Policy# contractors. I understand that a copy of the applicable law,Section 7044 of the
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:h0o://www.leoinfc.ra.aov/calow.htmi.
permit is issued.My workers'compensation insurance carder and policy number are:
Carrier 0/?65 Ins t-CJ Property OwnerorAulhorized Agent Date
Expires 1( 1Zl1 1`5 Policy# box 5d1y01
❑ By my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# 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(S100)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-
0 1 certify that in the performance of the work for which this permit is Issued,I identified p eny for the in ection purposes.
shall not emolov any persons in any manner so as to become subject to the a
workers compensation laws of California,and agree that if I should become
subject to the workers'compensation provisions of Section 3700 of the Labor Property Owner or Authorized Agent Date
Code.I shall forthwith comply with those provisions. �So36
(/� r Gm City Business License# 03
Date; / / S Applicant; f .Y IS'(1G� O50
WARNING: FAILURE TO SECURE 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, OYES OCCUPANT HANDLE HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES /jNO 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 DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address NO FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
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 OYES 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, XNO 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 \OES 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 ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than(S500).) CODE, SECTION 25505, 25533,AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING.
compensation,will ( )all or( ) porting of the work, and the structure is PROPER NER O IZED AGENT
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 X
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).
BUILDING
& SAFETY PERM IT/PLAN CHECK APPLICATION
`'=Menifee
DATE 1 ZT) i .J PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL 0-4SIDENTIAL O MULTI-FAMILY O MOBILE HOME OPOOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEWO PLyUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK ��l /"�U!/I Y�ILYC ✓LU�IV 'PAYS
J�Jl9�cc�
PROJECTADDRESS 2 D 5 0 W16&L TY eili 6i2- 'It Menifee
i3wicling a ty pt.
ASSESSOR'S PARCEL NUMBER LOT TRACT
lcvv�i�cG �'1c CL ;� ova DEC 0 1 2015
OWNER NAME /�
ADDRESS Z`>l S 6 / / G �Pzj 1 y - ke'1I (1GG RQcQmlfQ
PHONE R51 Zq6 %//'.�' 5 X EMAIL
APPLICANT NAME A J I C_,h SUY I D
ADDRESS /-IQ VIOj�Ca Av. Pvvv oIc�j cil G+ z566 5
PHONE I `6fl "3 S7 2Z `S % EMAIL 66MY 0-e-itMf
CONTRACTOR'S NAME ( ��/G I V OWNER BUILDER? O YES AO
BUSINESS NAMEiGi(JS
ADDRESS 12( !SS Y "W 06c11I Gl , "\,l Si� I?4 5�
PHONE 1 I-7 3-y ZZ b-7. EMAIL 'j0) V' 'LWynik e IGii7S- G0�
CONTRACTOR'S STATE
LIC NUMBER ! �73 y LICENSE CLASSIFICATION
VALUATION $ mo,;_ VV SO FT LSQ FT e�
APPLICANT'S SIGNATURE DATE li
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP �e
INVOICE PAID AMOU NT
AMOUNT , QI� OCASH 0 CHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH 0 CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of IVlenifee Building&Safety Department 29714 Haut)Rd. IA42.,i a2, CA 92585 951-6 72-6777
www.cityofinenifee.us lnsoection Request Line - ,=;5-5213