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PMT16-01265 City of Menifee Permit No.: PMT16-01265 29714 HAUN RD.<ACCEU/ MENIFEE, CA 92586 Type: Residential Electrical MENIFEE Date Issued: 04/2 212 0 1 6 PERMIT Site Address: 27830 GROSSE POINT DR, MENIFEE, Parcel Number: 335-164-023 CA 92586 Construction Cost: $4,376.00 Existing Use: Proposed Use: Description of ELECTRICAL PANEL CHANGE OUT 125AMP Work: Owner Contractor TOM FLEISCHMANN A R S AMERICAN RESIDENTIAL SERVICES OF 27830 GROSSE POINT DR CALIFORNIA INC MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201 Applicant Phone: 9512769744 KENNT PEERY License Number.765074 A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIi 965 RIDGE LAKE BLVD SUITE 201 MEMPHIS, CA 38120 Fee Description Oft Amount f51 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 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_Sldg_Permit Template.rpt Page 1 of 1 CITY 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 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law for Professions Code and my license license is in full force and effect. the following reason: �� License(lass r--! License No. By mysignature below I acknowledge that,except for my personal residence Expires �7Signature In which I must have resided for at least one year prior to completion of WORKER'S COMPENSATION DECLARATION improvements covered by this permit I cannot legally sell a structure that I have built as an owner-builder if it has not been constructed in its entirety by �I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that copy of the applicable law,Section have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Code,is available upon request when compensation,issued by the Director of Industrial 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. www.leainfo.ca.eav/calaw.html. Policy# Date O I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I certify to each of the following:I am the property this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this number are: �,.,-/- application and the information I have provided is correct 1 agree to comply Canter L—(.ez�-f � with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy#7 .2di5 Sal Z,IAI!/ Expires 1, - 'j,0 enter the abovetdentified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred dollars($100)or less Date PROPERTY OWNER OR AUTHORIZED AGENT ❑I certify that in the performance of the work for which this permit is issued, I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# workers compensation laws of California,and agree that if I should become RDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 3700 of the Labor Code,1 shall forthw th comply with those provisions. ill the applicant or future building occupant handle hazardous material or Applicant DateAgrd aa-/� mixture containing a hazardous material equal to orgreaterthatthe amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO S RE WORK S COMPENSATION COVERAGE IS ❑Yes .2-N-0 UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air quality Management econt(SCAionor See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo Coast Airlines Qua CONSTRUCTION LENDING AGENCY 0 Yes c3 o 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) ❑Yes 01W OWNER BUILDER DECLARATIONS 1 have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting. Business and Professions Code).Any city or county that requires a permit to OY 0 No L construct,alter,improve,demolish or repair any structure,prior to its "IL" Date issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR K0_R12ED that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING 1RRPI 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 licensure receiving compensation for most work that disturbs paint in a pre-1978 and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childrare facility to be RRP-certified firms and comply with than Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property an($500). managers who do the paint-disturbing work themselves or through their D 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA%Renovation Program visit: compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.eov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323). Code;The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project property who,through employees'or personal effort,builds or improves 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 have the burden of proving that it was not built or improved for the purpose of sale. ❑No EPA Lead Safe Certified Firm is required for this project because: ❑I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement. BUILDING & SAFETY • CHECKAPPLICATION Menifee DATE -OZ0�' ' PERMIT/PLAN CHECK NUMBER Ib� O' dIVS TYPE: O COMMERCIAL -etRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEWp O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK (�\ �ANGL stP�t�h as LA YF, gne— PROJECTADDRESS ( r,3LeLI tiM `�, C2 2C 666 ASSESSOR'S PARCEL NUMBER LOT 3 TRACT 383�1 OWNERNAME LfiiSCA1M M ADDRESS CCS ' Q U V PHONE (Yy5) 7R1 -473q EMAIL APPLICANT NAME M'v 4L. ADDRESS/ 3C>15 9-99-:5. j � (Ab C� PHONE l �� 666-0( / J EMAIL CONTRACTOR'S NAME 10 6 OWNER BUILDER? O YES O NO BUSINESS NAME & 7,,-vCm6- ADDRESS PHONE KCSZ51 61n -6675 EMAIL CONTRACTOR'S STATE LICNUMBER 76SO7q LICENSE CLASSIFICATION Q•( 3 Co?Q C VALUATION$ L, ? ,ff) SQ FT ( L SO FF�T�q APPLICANT'S SIGNATURE DATE OWN MR DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN ' SMIP d INVOICE PAID AMOUNT AMOUNT OCASH 0CHECK# OCREDITCARD VISA/MC FPN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC UILDER 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.cityofinenifee.us Inspection Request Line 951-246-6213