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PMT15-03886 City of Menifee Permit No.: PMT15-03886 29714 HAUN RD. Type: Residential Electrical <ACCELA—> MENIFEE, CA 92586 MENIFEE Date Issued: 12117/2015 PERMIT Site Address: 23483 VISTA WAY, MENIFEE, CA 92587 Parcel Number: 351-103-019 Construction Cost: $1,400.00 Existing Use: Proposed Use: Description of MAIN PANEL UPGRADE 200A Work: Owner Contractor NATHANIEL ERICKSON SMITH ELECTRICAL CONTRACTORS INC 23483 VISTA WAY 206 GREENFIELD DR STE G MENIFEE, CA 92587 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 O_yt Amount ISI 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 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 that I am licensed under provisions of 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 sod rqy 'tense is in full fo a and .I- which I must have resided for at least one year prior to completion of License Class I Licen 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 entirety by licensed I contractors. I understand that a copy of the applicable law,Section 7044 of the WORKERS'COMPENSATION DECLAF TI Business and Professions Code,is available upon request when this application is submitted or at the following Web site: ❑ 1 hereby affirm under penalty of perjury one of the following declarations: htto:/lwww.leainfo.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 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 i ued.My wo ors' ansation in urance carder and policy number are: with all applicable city and county ordinances and state laws relating to building (� /J construction.I authorize representatives of this city or county to enter the above- Carder identified property for the inspection purposes. Policy# lYuIAJ��''I V I Expires ID U I Dale Property Owner or Authorized Agent (This section need not be completed if the permit is for City Business License# one-hundred dollars($100)or less) I certify that in the Performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION shall not am to 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'com nation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the subject to the o pensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide? Code,I shall i Iy with those provision . - DYES ❑NO Applicant; Date; I� 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 ECU E WORKERS' Coast Alr Quality Management District(SCAQMD)?See permitting checklist COMPENS TION COVERAGE IS UNLAWFUL, AND SHALL for guidelines SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES ❑NO 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 a school? LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES ❑NO 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 State of agencyfor the performance of the work which this permit is issued (Section California Health&Safety Code,Section 25505 and 25534 concerning 3097 Civil Code) hazardous material reporting. OWNER BUILDER DECLARATIONS DYES ❑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 IRRPI 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 EPA's Renovation Program visit: www-epa.govAead or contact the National Lead Information Center at ❑ I, as owner of the property, or my employees with wages as their sole 1-800-424-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 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 safe.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 Firm Certification No.: purpose of sale). ❑ I, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Finn is required for this project bemuse: contractors to construct the project(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of a property who builds or improves thereon, and who contracts for the projects with a r...........a......,.....«.dot...n.......,,..,w..r...a....a...�e,�,e I L.e.,I-A If vnur nminM dnne nnf H.with PPC PPP min nlnnee fill nut fhn RRP BUILDING & SAFETY PERMIT/PLAN . . • ��Menifee DATE J 1 1 PERMIT/PLAN CHECK NUMBER - Q TYPE: O COMMERCIAL XRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN _ SUBTYPE: O ADDITION O ALTERATION O DEMOLITION XELECTRICAL O MECHANICAL o((�� O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES (I `� l ( V DESCRIPTION OF WORK &YI C C ane- l'GDATO 12s� PROJECTADDRESS ASSESSOR'S PARCEL NUMBER , 0 � - lU( '( d y� LOT TRACT OWNERNAME ADDRESS PHONE " /VI - lk'W V (' EMAIL APPLICANT NAME J �I s ADDRESS Z��D kd GCf Dn Zo�-O PHONE rpI(,�.�Sg'� L�29 JoS EMAIL S YYI CONTRACTOR'S NAME ff Pf-V S ITS OWNER BUILDER? O YES s�s7N0 BUSINESS NAME I n -Ie.ofi cat Conf -chi Inc, ADDRESS 2Z re-en I d COL O Yl CA91'2-bZO PHONE (DI Cf' 1 Sg` Ci OLq EMAIL dQvesmi-l-I� S I �Z�'f�i(.Sd • C.orn CONTRACTOR'S STATE LIC NUMBER b I Irlo O LICENSE CLASSIFICATION C- O VALUATION$ 1400 A � FT L SQ FT � APPLICANT'S SIGNATURE _ DATE DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN , SMIP -,,o INVOICE PAID AMOUNT (�y('�\ O CREDIT CARD VISA/MC MC AMOUNT � 1 'b�J OCASH OCHECK# A/ PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZEDLETTER O YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.citycfinenifee.us Inspection Request Line 951-246-6213