PMT16-00747 City of Menifee Permit No.: PMT16-00747
_ 29714 HAUN RD. Type: Residential Electrical
<-ICCELA— MENIFEE, CA92586
MENIFEE Date Issued:
03/17I2016
PERMIT
Slte Address: 30065 WOODBINE LN, MENIFEE, CA Parcel Number: 472-040-002
92584 construction cost: $18,000.00
Existing Use: Proposed Use:
Description of MAIN PANEL UPGRADE 400A WITH NEW 200A SUBPANEL
Work:
Owner Contractor
SCOTT CAMERON A R C ELECTRIC INC
30065 WOODBINE LANE 33105 JAN CIRCLE
MENIFEE, CA 92584 MENIFEE,CA 92584
Appllcant Phone:9517128074
CHRISTOPHER ROSA License Number: 1004144
A R C ELECTRIC INC
33105 JAN CIRCLE
MENIFEE,CA 92584
Fee Description O_yt Amount($1
Services,Switchboards,Control Centers&Panels 2 232.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Electrical 1 11.60
$271.60
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
CFFY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7DOO)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason;
License Class_C_ t V Licens o. /00 By my signature below I acknowledge that,except for my personal residence
Expires 6-30-1-7 SiRnature in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKEWS COMPENSATION DECLARATI have built as an owner-builder if it has not been constructed in its entirety by
o I hereby affirm under penalty of perj one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will mai �w ent of self-insure for worker's 7044 of the Business and Professions code,is available upon request when
compensation,issued by trip Director of Ind,�triai Relations as provided for this application is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. vvvvvv.IeRinfo.ca.flov/calaw.html.
Policy Date
o I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which o By my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier i, Irk S L,/i'le( 4 Q-�Pv/� With all applicable city and county ordinances and state lam relating to
building construction.I authorize representatives of this city or county to
Policy# Eoxtpires V2 L enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify 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 become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workr's co nsation provisions of Section 3700 of the Labor
Code,I shall fo th c y with those provisions. Will the applicant or future building occupant handle hazardous material or a
Acrilicant Date mixture containing a hazardous material equal to or greaterthatthe
amounts specified on the Hazardous Materials information Guide?
WARN/ING' ILURE TO SECUREWORKEWS COMPENSATION COVERAGE IS oYes allo
UNLAWFU AND SHALL SUBJECrAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
ANDOV FINES UP TOONE HUNDRED THOUSAND DOLLARS($200,000),IN occupant require a permit for the construction or modification from South
ADDITI TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
INSE ]ON 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY o Yes o No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) o Yes o No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have plac�ed next to the applicable item(s)(Section 7031.5 oYes o No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWN ER OR AUTHORIZED AGE NT
issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AN D PAINTING(RRP1
License Law(Chapter 9(commencing with section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from I icensure receiving compensation for most work that disturbs paint In a pre-1978
and the basis for the al leged exemption.Any violation of Section 7031.5 by residence or chi ldcare faciJity to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental Property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
u 1,as owner of the property,or my employee with wages as their sole employees.For mom information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eva.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-BDD-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,th rough employees!or personal effort,builds or Imp roves the
property provided that the Improvements are not intended or offered for Certified Firm Name:
sale.if,however,the building or improvement Is sold Within one year of Firm Certification No.:
completion,the Owner-Builder will haw the burden of proving that it was
not built or improved for the purpose of sale. a No EPA Lead-Safe Certified Fi irm is required for th is project because:
o 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please III I out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE l7 PERMIT/PLAN CHECK NUMBER U -
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOB E HOME O POOL/SPA O SIGN
SUBTYPE: 0 ADDITION O ALTERATION >DEMOLITION &JELECTRICAL O MECHANICAL
�% NEW O PLUMBING C RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK L 200 00 AnIp
0b e- 117, Aftp S"I L 100
PROJECTADDRESS 00
ASSESSOR'S PARCEL NUMBER -(ona LOT �F?_ TRACT 17,3 L Ok
City Of menil
Opt.
OWNER NAME ildin & Safety
ADDRESS 3 is M&It/ t G,4 92.SSVZ 16
PHONE 451 75 7 gZ3l EMAIL r cobn
APPLICANT NAME
ADDRESS •3 3
PHONE 6),S/ ')I:� e&-)q EMAIL q `/
CONTRACTOR'S NAME/� OWNER BUILDER? O YES 7AO
BUSINESS NAME A R / f
ADDRESS 33105 -% re. S
PHONE C151 !930 7907 EMAIL
CONTRACTOR'S STATE LIC NUMBER O O <•f Cy LICENSE CLASSIFICATION C.
VALUATION$tf �f( D OCJ SOFT L SQ FT
APPLICANT'S SIGNAT7TURE DATE 3
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP x
INVOICE /'� � �/� PAID AMOUNT t,, i;
AMOUNT a `' VCV •�yc� OCASH CHECK# GCREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# C CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213