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PMT16-00543 City of Menifee Permit No.: PMT16-00543 29714 HAUN RD. Type: Residential Electrical S�CCELA7. MENIFEE, CA 92586 MENIFEE Date Issued: 0 310 312 01 6 PERMIT Site Address: 27224 EMBASSY ST, MENIFEE, CA Parcel Number: 335-333-005 92586 Construction Cost: $1,500.00 Existing Use: Proposed Use: Description of MAIN PANEL UPGRADE 200A Work: Owner Contractor LARNA LEI LOVE VISION INSTALLATION 27224 EMBASSY STREET 5255 N EDGEWOOD DR_125 MENIFEE, CA 92586 PROVO, UT 84604 Applicant phone:8887817074 SHAYLEN FAJARDO License Number.853582 VISION INSTALLATION 5255 N EDGEWOOD DR_125 PROVO, CA 84604 Fee Description D1t rr Amount ISl 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 forfefted. AA_Bldg_Permit_Template.rpt Page 1 of 1 'Atl,�y 12OW3131eRuaPlsa�! ❑ I am exempt from licensure under the Contractors State License Law for the "= following reason: le by affirm under penalty or perjury that I am licensed under provisions of signature below I acknowledge that, except for my personal residence in hooter 9(commencing with section 70Q0)of Division 3 of the Business and y which I must have resided for at least one year prior to completion of rofessions Code and my license is in full force and eff $ improvements covered by this permit,I cannot legally sell a structure that I have tcense Class License No. � � /��1 built as an owner-building if it has not been constructed in its entirety by license :xplres�LL--L.—I— Signaler contractors. i understand that a copy of the applicable law,Section 7044 of the Business and Professions Code,is available upon request when this application is JORKERS'COMPENSATION DECLARA submitted or at the following Web site: ,hereby affirm under penalty of perjury one of the following declarations: hffix/www lecinfo Ga.aov/calaw.html. -save and will maintain a certificate of consent of self-insure for workers' Date ompensation,issued by the Director of Industrial Relations as provided for by ;ection 3700 of the Labor Code, for the performance of work for which this Property Owner or Authorized Agent ermit is issued. A ❑ By my Signature below, I certify to each of the following: I am the property 'olicy# owner or authorized to act on the property owner's behalf. I have read this RLI have and will maintain workers compensation insurance, as required by application and the information I have provided is correct. I agree to comply action 3700 of the Labor Code, for the performance of the work for which this with all applicable city and county ordinances and slate laws relating to building iermit Is issued.My workers'compensation insurance carrier and policy number are,. costruction.I authorize representatives of this city or county to enter the above- 4' 1deniproperly for if e' spectio purposes. Dale>olicy#9ng�r)� Expires Own r Authorized Agent 1:7c�r/s 'This section need not be completed if the permit is for City Business License# O —— • ��0 ;ne-hundred dollars($100)or less) HAZARDOUS MATERIAL DECLARATION {jycerlify that in the performance of the work for which this permit is issued,I shall not employ.any persons in any manner so as to became 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 pecified on the Hazardous Materials Information Guide? Code*shal1orthw11th&PIY with those provisions. ❑YES �NO �p��.�, q ia1- f5 Will the i/intended use of the building by the applicant or future building "a; 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 guldYES CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS eh g SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND Will the proposed building or modified facility be within 1000 feet of the outer ($100,000), IN ADDITION TO THE COST OF COMPENSATION, boundary of a school? DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE; INTEREST,AND ATTORNEYS FEES []YES 5 ND 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 Stale of agency for the performance of the work which this permit is issued (Section hazzfornia ,ealtth.& g. Sefety Code,Section 25505 and 25534 concerning 3097 Civil Code) ❑YE ,`-!L',��.", �( ' OWNER BUILDER DECLARATIONS Date I hereby affirm under penalty of perjury that I am exempt from the Contractor's OP RTY O\! ER OR AUTHORIZED AGENT Ucense Law for the reason(s)indicated below by the checkmark(s)I have placed next to the applicable item(s)(Section 7031.5.Business and Professions Code: EPA RENOVATION REPAIR AND PAINTING(RRP) Any city or county that requires a permit to construct, alter,improve,demolish, air and Painting(RRP)Rule requires contactors or repair any structure, prior to its issuance, also requires the applicant for the The EPA Renovation, p permit to file a signed statement that he or she is licensed pursuant to the receiving compensation for most work that disturbs paint in a pre-1978 provisions of the Contractors State License Law(Chapter 9(commencing with residence or childcare facility to be RRP-cer0fied firms and comply with Section 7000)of Division 3 of the Business and Professions Code)or that he or required practices.This includes rental property owners and property she is exempt from licensure and the basis for the alleged exemption. Any managers who do the paint-disturbing work themselves or through their violation of Section 7031.5 by any Applicant for a permit subjects the applicant to employees.For,more Information about EPA's Renovation Program visit: a civil penalty of not more than($500).) 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 1-800424-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 p who, through employees' or personal effort, builds or improves the rop e 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- Firm Certification No.: Builder will have the burden of proving that it was not built or improved for the purpose of sale). sed ❑No EPA Lead-Safe Certified Finn is required for this project because: ❑ I, as owner of the property an exclusively contracting with licen 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 If your project does not comply with EPA RRP rule please fill out the RRP licensed contractor(s)pursuant to the Contractors State License Law). Acknowledgement.