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PMT16-00392 City of Menifee Permit No.: PMT16-00392 29714 HAUN RD. Type: Residential Electrical <ACCELIA. MENIFEE,CA 92586 MENIFEE Date Issued: 02116/2016 PERMIT Site Address: 25790 TRUMBLE RD, MENIFEE, CA Parcel Number: 329-240-011 92585 Construction Cost: $1,400.00 Existing Use: Proposed Use: Description of REPLACE 200AMP ELECTRICAL SERVICE PANEL Work: Owner Contractor SERGIO GAMIZ SMITH ELECTRICAL CONTRACTORS INC 25790 TRUMBLE RD 206 GREENFIELD DR STE G MENIFEE,CA 92585 EL CAJON, CA 92020 Applicant Phone: 6197589829 JANE RECKTENWALD License Number.871200 SMITH ELECTRICAL CONTRACTORS INC 206 GREENFIELD DR STE G EL CAJON,CA 92020 Fee Description Qtv Amount IS) 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 staled,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,shalt expire,and fees paid shall be forfeited. AA_Bidg_Permit_Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ lam exempt from]!censure 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 C 0 License No.45_"((G.Ct) improvements covered by this permit, I cannot legally sell a structure that I have Expires.X W— 6 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 DECLARATION Business and Professions Code,is available upon request when this application is submitted or at the fallowing Web site: ❑ I hereby affirm under penalty of perjury one the following declarations: htto://www.leginfo.ca.gov/calaw.html. I 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 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 ❑ 1 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 issued.My workers'compensation insurance carder and policy number are: with all applicable city and county ordinan s and state laws relating to building L construction.I authorize representatives of is city or county to enter the above- Carrier GV2fP5"If• identified property for the insp purpos s. t r Policy#-1uciz lb V/ O Expires (6-7'3—l� Date oZ--1tc y`N Property Owner or Auth ri (This section need not 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 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 forthwi mply with those provisions. ff DYES ❑NO Applic nt; Date; ;I Au Ai6 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 ❑NO CML 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 agency for 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(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 firths 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.gov/lead 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(6323). 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). ❑ I, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Firm 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 Acknowledgement. APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK DATE 2-16-16 PERMIT/PLAN CHECK NUMBER TYPE: COMMERCIAL VRESIDENTIAL MULTI-FAMILY MOBILE HOME POOL/SPA SIGN SUBTYPE: ADDITION ALTERATION : DEMOLITION VELEcTRICAL MECHANICAL NEW _, PLUMBING RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK Replace service panel - 200 amps PROJECTADDRESS 25790 Trumble Rd Romoland CA 92585 ASSESSOR'S PARCEL NUMBER 329-240-011 LOT TRACT OWNER NAME Serc Jo Gamiz ADDRESS ble Rd Romoland uildin CA 9258513 Clfy Of fet ee 8 Safety Dept. PHONE 619-806-1558 EMAIL FED APPLICANT NAME Jane Recktenwald ,.g ADDRESS Received PHONE 714-336-6159 EMAIL CONTRACTOR'S NAME Smith Electrical OWNER BUILDER? BYES ENO BUSINESS NAME Smith Electrical ADDRESS 206 Greenfield Dr Ste G El Cajon, CA 92020 PHONE 619-758-9829 EMAIL CONTRACTOR'5 STATE UC NUMBER 871 200 LICEN CLASSIFICATION CIO VALUATION $ 1400.00 SO FT L SO FT APPLICANT'S SIGNATURE DATE 2-16-16 DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT CASH CHECK IfCREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT CASH CHECK It CREDIT CARD VISA/MC OWNER BUILDER VERIFIED '-%YES NO DL NUMBER NOTARIZED LETTER YES NO City of Menefee Building&Safety Department 29714 Haun Rd. Menefee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line951-246-6213