PMT15-03805 City of Menifee Permit No.: PMT15-03805
29714 HAUN RD.
1�-�CCEL/� MENIFEE, CA 92586 Type: Residential Electrical
MENIFEE Date Issued: 12/10/2015
PERMIT
Site Address: 25289 COUNTRY FAIR DR, MENIFEE, CA Parcel Number: 339-393-017
92584 Construction Cost: $1,400.00
Existing Use: Proposed Use:
Description of ELECTRICAL PANEL UPGRADE TO 200AMP FOR SOLAR PERMIT PMT15-03243
Work:
Owner Contractor
JENNA ROY SMITH ELECTRICAL CONTRACTORS INC
25289 COUNTRY FAIR DR 206 GREENFIELD OR STE G
MENIFEE, CA 92584 EL CAJON, CA 92020
Applicant Phone:6197589829
SASHA PETERSON License Number:871200
SMITH ELECTRICAL CONTRACTORS INC
206 GREENFIELD DR STE G
EL CAJON, CA 92020
Fee Description QtV Amount I$
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 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 ❑ lam exempt from licensure under the Contractors'State License Law for the
following reason:
I hereby affirm under penalty or perjury the am licensed under provisions of
Chapter 9(commen ing with section 7000 Divi on 3 o t e B 'neess and By my signature below I acknowledge that,except for my personal residence in
Professions Code m nse is in full a ffe I Y 1 which I must have resided for at least one year prior to completion of
License Class Li I 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 entirely by licensed
UV contractors. I understand that a copy of the applicable law, Section 7044 of the
WORKERS'COMPENSATION DECLA TIO 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 o e of the fallowing declarations: htto://www.leoinfo.ca.aov/calaw.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
I 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
ion 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 is g r� coin s'do i suragce Cartier and policy number are: with all applicable city and county ordinances and state laws relating to building
I I, y �/)r1 I construction.I authorize representatives of this city or county to enter the above-
Carder SC 'l Y ��1,� Identified property for the inspection purposes.
Policy# Expires 10127,110
Date
Property Owner or Authorized Agent
(This section need IQ be completed if the permit is for City Business License#
one-hundred dollars($100)or less)
❑ 1 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 California, and agree that if I should become mixture oont ' ing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts sIfecified on the Hazardous Materials Information Guide?
Code,I shall forthwith comply with those provisions. DYES ❑NO
Applicant; 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 QualiJJ,JJ}yyy Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelir,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES ❑ 0
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 chool?
LABOR CODE,INTEREST,AND ATTORNEYS FEES ❑YES Jd
CONSTRUCTION LENDING AGENCY I have read the Haza ouslMateriaI Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending pernitting checklist.IJVSeycl,
Iquirements under the State of
agency for the performance of the work which this permit is issued (Section California Has &Sn 25505 and 25534 con emi g
3097 Civil Code) hazardous terial r L
OWNER BUILDER DECLARATIONS DYES NO
I hereby affirm under penally 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 R UTHORIZED 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 RRP
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($500).) employees.For more information about EPKs Renovation Program visit:
❑ I, as owner of the property, or my employees with wages as their sole www.epa.gov/lead or contact the National Lead Information Center at
1-800-424-LEAD(5323).
compensation,will do ( )all of or( )parting of the work,and the structure is
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 ❑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 Finn 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 Firm Certification No.:
purpose of sale).
❑ 1, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Finn 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
Acknnwlednnmenf
: SAFETY PERM IT/PLAN CHECK APPLICATION
AMenifee
DATE PERMIT/PLAN CHECK NUMBER D�
TYPE: O COMMERCIAL XRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION MELECTRICAL O MECHANICAL
O NEW OI ,P,LUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK C,'.r'LQ. Panel
PROJECTADDRESS
3 - 'f
ASSESSOR'S PARCEL NUMBER 3`� '-� LOT TRACT
OWNER NAME
ADDRESS L J
PHONE I v� r I"l n /; I` EMAIL
APPLICANT NAME
ADDRESS 2b U/ (4'O n CPr 9?0' b
PHONE tp lq_15g-61 S29 k►' pS EMAIL 2 - S m
CONTRACTOR'S NAME V P S ITH OWNER BUILDER? O YES ONO
BUSINESS NAME -�eCfY�CQ.I Con-f- zLUbr , nc.
ADDRESS 20 Lo eo�enfield Dr. Ca o n Cry �2_6 Lo
PHONE (_PI q- 58- q SZ4 EMAIL dQV2Smi }� S 1 I lec¢ricS - Com
CONTRACTOR'S STATE LIC NUMBER J 1 I,10O LICENSE CLASSIFICATION C—10
VALUATION$ q Q Q I n FT L SQ FT
APPLICANT'S SIGNATURE - DATE l•I l l ,J
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN 1 SMIP
INVOICE PAID AMOUNT
AMOUNT U CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZEDLETTER 0 YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92585 951-672-6777
www.cityofinenifee.us Inspection Request line 951-246-6213