PMT16-00174 City of Menifee Permit No.: PMT16-00174
29714 HAUN RD. Type: Residential Electrical
'CA—CCEL/-> MENIFEE, CA92586
MENIFEE Date Issued:
01I2112016
PERMIT
Site Address: 30115 VIA DEL FIERRO, MENIFEE,CA Parcel Number: 364-094-015
82584 Construction Cost: $1,400.00
Existing Use: Proposed Use:
Description of MAIN PANEL UPGRADE 200A
Work:
Owner Contractor
FRANCISCO AYALA SMITH ELECTRICAL CONTRACTORS INC
30115 VIA DEL FIERRO 206 GREENFIELD DR STE G
MENIFEE,CA 92584 EL CAJON, CA 92020
Applicant Phone:6197589829
SASHA PETERSON License Number. 871200
SMITH ELECTRICAL CONTRACTORS INC
206 GREENFIELD DR STE G
EL CAJON, CA 92020
Fee Description Qtv Amount($I
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_B1dg_Permit_Temp1ate.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 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(corn ncin th section 7000)of Division 3 of the Business and By my signature below I acknowledge that,except for my personal residence in
Professions Co nd I cerise is in full to a elf which I must have resided for at least one year prior to completion of
License Class Lice lJ 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
contractors. I understand that a copy of the applicable law, Section 7044 of the
WORKERS'COMPENSATION DECLA tJ 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:I/www.leginfo.ce.eov/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# 0 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 37 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 ec{. in tibn in 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 O identified property for the inspection purposes.
Policy# �xpires Date
Property Owner or Authorized Agent
(This section need not completed if the permit is for City Business License#
one-hundred dollars($100)or less)
❑ 1 certify t at in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not 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' ens lion laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to mpensation provisions f Sectio 3700 of the or amounts sp cified on the Hazardous Materials Information Guide?
Cade,I sh I ly with those provisi ❑YES O
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
WARNIN. FA LURE TO ECU E WORKERS' Coast Airity Management District(SCAQMD)?See permitting checklist
COMPEN ATION COVERAGE IS UN AWFUL, AND SHALL for guidelin
SUBJEC AN EMPLOYER TO CRIMINAL PENALTIES AND DYES NO
CIVIL FIN S 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 school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES ❑ O
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 and rstand my requirements under the State of
agency for the performance of the work which this permit Is issued (Section California Health&SafIf
e,Section 25505 and 25534 c ncem' g
3097 Civil Code) hazardous m nal
OWNER BUILDER DECLARATIONS DYES ❑ O i ( -J '1
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's Date I Q)/
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER AUTHORI D AGENT
next to the applicable item(s)(Section 7031.5.Business and Professions Code: EPA RENOVATIONI
PAIR AND PAINTING Any city or county that requires a permit to construct, alter, improve, demolish,
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
❑ I, as owner of the roe www.epa.gov/lead or contact the National Lead Information Center at
property,rty, 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 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 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
Acknowledqement.
: SAFETY PERM IT/PLAN CHECK APPLICATION
Menifee
DAT�JA PERMIT/PLAN CHECK NUMBER Q
TYPE: O COMMERCIAL XRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION RELECTRICAL 0 MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK POnC V
PROJECTADDRESS f / - l
ASSESSOR'S PARCEL NUMBER • 3LO LA'• L'I ' LOT TRACT
City 0
OWNER NAME Building & Safety Dept.
ADDRESS JAN 2 1 2016
PHONE W V EMAIL
Hl
ed
APPLICANT
� Lip MiNAME
I" �.L rs e�',e I V
ADDRESS -b u n 2�o-z-o
PHONE (_pjq-j Gg-q gZq �Q O(; EMAIL ' n
CONTRACTOR'S NAME S m I TH OWNER BUILDER? O YES ONO
BUSINESSNAME t -JC.(JT CCLI COrrVMChrr InC.
ADDRESS 20 re-erI el d Or. # 6 gj C.W o n Cf `2-62.Q
PHONE Jpl q- '159- Of gz4 EMAIL daVGsmi S I �Z�frt'(S • Com
CONTRACTOR'S STATE LIC NUMBER ti 1 IrLO O LICENSE CLASSIFICATION C-I O
VALUATION'$ I+0 Q j FT L SQ FT
APPLICANTS SIGNATURE DATE I
CITY STAFF USE ONLr
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP )C
INVOICE PAID AMOUNT , L p��
AMOUNT Q 1• � ��{�• p\/ O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK If O CREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER C) YES O NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-5777
www.cityofinenifee.us Inspection Request Line 951-246-6213