PMT16-02741 City of Menifee Permit No.: PMT1 6-02741
29714 HAUN RD. Type: Residential Electrical
<A—CCELA> MENIFEE, CA92586
MENIFEE Date Issued: 0812212016
P E R M I T
Site Address: 25600 ANTELOPE RD, MENIFEE, CA Parcel Number: 329-120-028
92585 Construction Cost: $100.00
Existing Use: Proposed Use:
Description of REPLACE DAMAGED ELECTRICAL PANEL 200AMP
Work-
Owner Contractor
AURELIO&ELIZABETH MENDOZA
25572 ANTELOPE RD
MENIFEE,CA 92585
Applicant License Number:
AURELIO&ELIZABETH MENDOZA
25572 ANTELOPE RD
MENIFEE, CA 92585
Phone: 9514425133
Fee Description Ply Amount
Receptacle,Switch, Outlet&Fixture 1 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 0.00
General Plan Maintenance Fee-Electrical 1 5.80
$148.80
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of enors 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.
�g Perrnit 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 u nder 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 a 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 License No. By my signature below I acknowledge that,except for my personal residence
Expires_Signature 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
WORKER'S COMPENSATION DECLARATION have built as a n owner-builder if it has not been constructed in its entirety by
ci I hereby affirm under pena Ity of perju ry one of th e following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insu re for worker's 7044 of the Business and Professions Code,is available upon req uest 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 La bor Code,for the performance of work for which
this permit is issued. www.IeRinFo.ca.gov/caIaw.htmI.
Policy It 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 ci 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 an the property owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
Policy# Expires enter the above identified property for inspection purposes.
(This section need not to be com pleted is the permit is for one-h undred e*-�' �!��—Vlt-
dollars($100)or less ROPERTY OWNER OR AUTHORIZED AGENT
o I certify that In the performance of the work for which this permit is issued,
I shall not empi any persons in any manner so as to become subject to the CITY BUSINESS LICENSE It
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith complywith those provisions. Will the applicant or future building occupant handle hazardous material ora
mixture containing a hazardous material equal to orgreater thatthe
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKEWS COMPENSATION COVERAGE 15 o Yes u No
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($100,0001,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 District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST�AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ciYes oNo
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) a Yes a No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQM D
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California H ealth&Safety Code,Section 25505 a nd 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous material reporting.
checkma rk(s)I have placed next to the applicable item(s)(Section 7031.5 oYes o No
Business and Professions Code).Any city or county that requires a permitto Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant far 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 AND PAINTING IRRPI
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 com pensation 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 childcare facility 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 orthrough their
o 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.00v/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 Contractor's State License Law does not apply to an owner of a ci 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 on e year of Firm Certification No.:
completion,the Owner-Builder will have the bu rden of proving that it was
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project beca use:
o 1,as owner of the property am exclusively contracting%vith 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 fi 11 out th e RAP
Acknowledgement.
:91 Ed III Komi mummmum I ze"I
Menifee
DATE Aujug -Z&J, zoi6 PERM IT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL ARESIDENTIAL 0MULTI-FAMILY OKMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOUTION RKELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
-10S 0 %met
DESCRIPTION OF WORK +a1C,+i0tn 4 otvi ejeCtrir-,%( Ra"ej ( P�-,i
R&O
PROJEcTADDRESS Z.5600 Atn+e(ag- Q� Mewfea- u cizsgs
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME Au(,el'o I- Qzak-K MetJoza
ADDRESS -Z S�37Z A tA k(ope M -Pee CA 9z@-:9:9 q z.3 9
PHONE (9sj) 40- 3133 EMAIL
APPLICANT NAME Aureli o MaA doz,c,
ADDRESS Z S37Z A,,4-el ope r j tj e.,4e C,4 9-Z -3 F,5
PHONE � 95f) 44-z-S/33 EMAIL —
CONTRACTORS NAME OWNERBUILDER? OYESONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SO FT L SO,FT
APPLICANT'S SIGNATURE DATE AUCIU54 'ZZI-J , 7016
FRAM" j i - .. I� w wiff.40N
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP � I
INVOICE (I A. PAIDAMOUNT CASH OCHECK# OCREDITCARD VISAIMC
AMOUNT I 'ICI
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISAIMC
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.cityeftnenifee.us Inspection Request Line 951-246-6213