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PMT16-02760 City of Menifee Permit No.: PMT16-02760 29714 HAUN RD. Type: Residential Electrical <A—CCELA—> MENIFEE, CA 92586 MENIFEE Date Issued: 08123/2016 P E R M I T Site Address: 30195 WESTLAKE DR, MENIFEE, CA Parcel Number: 364-023-004 92584 Construction Cost: $1,800.00 Existing Use: Proposed Use: Description of MAIN PANEL UPGRADE 200A Work: Owner Contractor CLIFFORD RUSSEL SERVICE TEAM OF PROFESSIONALS TEMECULA 30195 WESTLAKE DRIVE 33794 WAGON TRAIN DR MENIFEE,CA 92584 W LDOMAR, CA 92595 Applicant Phone: 9512461001 KENNETH KLOTZ License Number.976252 SERVICE TEAM OF PROFESSIONALS TEMECULA 33794 WAGON TRAIN DR WILDOMAR, CA 92595 Fee Description ON Amount($ 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 forfeited. AA Bldg_Pe"it—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 a in 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 Hcensure under the Contractoes State License Law for Professions Code and my license is in full force and effect. the following reason: License Class—&10 License No. 1-76 7-17 T— By my signature below I acknowledge that,except for my personal residence Expires 4� Signature ILez in which I must have resided for at least one year priorto completion of improvements covered bythis permit.I cannot legallysell a structure that I WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed In its entirety by a I hereby affirm under penalty of perjury one of the 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-insure for workees 7044 of the Business a nd 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 www.leginfo.ca.gov/calaw.htmL this permit is issued. Policy# PROPERTY OWNER OR AUTHORIZED AGENT Date ad have and will maintain worker's compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which a By my signature below I certify to each of the following:I a in the property this perm it is issued.My worker's com pensation insura nce carrier a nd policy owner or authorized to act on the property ownees 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 It/ 7) enter the above identified property for Inspection purposes. (This section need not to be completed is the permit Is for one-hunifired Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT ci I certify that in the performance of the work for which this permit is issued, I shall not em play any persons in any in anner 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 workees compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a le� mixture containing a hazardous material equal to or greater that the Applicant 11- 7,.e,' Date amounts specified on the Hazardous Materials Information Guide? WARNING:FAILLIRFTO SEAE WORKER'S COMPENSATION COVERAGE IS 0 Yes PMO UNLAWFUL,AND SHALL SUBJECTAN 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($100,0110),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 oYes Ao I hereby affirm that under the penalty of perjury them is a construction Will the proposed building or modified facility he within 1000 feet of the lending agency for th e performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) ci Yes AwNo 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 placed next to the applicable item(s)(Section 7031.5 s oNo Business and Professions Code).Any city or county that requires a permit to :54ye ;;Oe? lg--- Date construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNI�5�15TK15RIZED AGENT issuance,also requires the applicant for the permit to file a signed statement 4 that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRPI License Law(Chapter 9(commencing wifth Section 70011)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 ficensure receiving compensation for most work that disturbs paint in a pre-1978 and the basis for the alleged exemption.Any violation of Section 7031.S by residence or childcare facility to be RRP-certified firms and com ply with an Applicant for a permit su bjects the applica nt to a civil Pena Ity 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 o I,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 I I all of or I )portion of the work,and the structure is www.epa-Rcv/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 o 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. o No EPA Lead-Safe Certified Firm is required for this project bemuse: 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 fill out the RRP Acknowledgement. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION Menifee _Z% ANik- 1- DATE SLZ-- 3�/16 PERIMIT/PLAN CHECK NUMBER TYPE: OCOMMERCIAL 0i0RESIDENTIAL " MULTI-FAMILY OMOBILEHOME '_' POOL/SPA CISIGN SUBTYPE: ��ADDITION COALTERATION ODEMOLITION kELECTRICAL 11 MECHANICAL ' NEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK (A �rj(-494 e__ I j PROJECT ADDRESS DC> e- TRACT City of Menime ASSESSOR'S PARCEL NUMBER LOT OWNERNAME Building & Sal'ety Dept. ADDRESS AUG 2 3 2016 PHONE EMAIL Reeeived APPLICANT NAME �mem6p-� pof -Z, ADDRESS _4,,3!7� ��,0.- tnlc tzA PHONE I<(— 76 -Z67t�t EMAIL CONTRACTOR'S NAME 150�f2)e�� OWNER BUILDER? C YES #NO BUSINESS NAME '"ADDRESS PHONE C-( 7_0 7_ EMAIL CONTRACTOR'S STATE LIC NUMBER 1-7 LICENSE CLASSIFICATION —do VALUATION $ 1 5m SO FT L SQ FT APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION _7�IFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE � GREEN SMIP INVOICE PAID AMOUNT .9�p AMOUNT CASH CHECK# CREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED Q YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES C. NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofn7enifee.Lis Inspection Request Line 951-246-6213