PMT16-02901 City of Menifee Permit No.: PMT16-02901
29714 HAUN RD. Type: Residential Electrical
'tA—CCEL:A'J' MENI FEE, CA 92586
MENIFEE Date Issued: 11/0112016
P E R M I T
Site Address: 28691 ERIDANUS DR, MENIFEE, CA Parcel Number: 339-271-010
92586 Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of MAIN PANEL UPGRADE 125A
Work:
Owner Contractor
ADRIANNA SHREM SOLCIUS LLC
28691 ERIDANUS DRIVE 1145 SOUTH 800 EAST SUITE 201
MENIFEE, CA 92586 OREM, LIT 84097
Applicant Phone:8018994541
KRISTEN SCHOW License Number: 976336
SOLCIUS LLC
12155 MAGNOLIA AVE, STE 12 B/C
RIVERSIDE, CA 92503
Fee Description Amount
Services,Switchboards, Control Centers&Panels 116.00
Building Permit Issuance 27.00
GREEN FEE 1.00
General Plan Maintenance Fee-Electrical 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.
AkBIdg2enrnit-Ternplate.rpt Page 1 of I
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 ci I am exempt from licensure under the Contractoes state License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class 6-10 License No. "97430 By my signature below I acknowledge that,except for my personal residence
Expires `713till"7- Signature in which I must have resided for at least one year prior to completion of
improvements covered by this 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
o 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 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.Ieginfo.ca.gov/caIaw.htmI.
Policy It Date
Af�have and will maintain workees compensation Insurance,as required by PROPERTY OWNER ORAUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which in By my signature below I certify to each of the following:I a m the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property ownees behalf.I have read this
number a re- application and the information I have provided is correct.I agree to comply
'PC,11 C�o with all a pplicable city and county ordinances a nd state laws relating to
Carrier building construction.I authorize representatives of this city or county to
Policy# 5 C" G t'6 110 Expires r(/v / 16 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 ORAUTHORIZED AGENT
in I certify that in the performance of the work for which this permit is isisued,
I shall not employ any persons In any ma nner so as to become subject to the CITY BUSINESS LICENSE#
workees compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workees compengs "on provisions of Section 3700 fthe abor
/is I
Code,I shall forl"",compi those prin sions. Wil the applicant or future building occupant handle hazardous material or a
// 61 mixture containing a hazardous material equal to or greater that the
Applicant [late 764o 7, �
on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS a Yes P-NZO
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or futu re building
AND CIVI L F]NES UP TO ONE HU N DRED 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 District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY 0 Yes EINC
I herebyaffirm that underthe penalty of perjurythere is a construction Will the proposed building or modified facility be within 1000 feet of the
lenclinj agency for the performance of the work which this permit is issued outer bounda of a school?
(Section 3097 Civil Code) a Yes �7
OWNER BUILDER DECLARATIONS I 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
Contractoes License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checknia rk(s)I have placed next to the applicable item(s)(Section 7031.5 h"ardaus materialreportin&/
'Yes a No��� 1,11,6
Business and Professions Code).Any city or county that requires a permit to Date /I
construct,alter,improve,demolish or repair any structure,p ior to its
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractoes state EPA RENOVATION,REPAIR AND PAINTING IRRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Reno%ration,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 childcare facility to be RRP-certifted firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes renta I property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
ci 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.epagoyllead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-SOG-424-LEAD(5323).
Code,The Contrectoes 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 said 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. a No EPA Lead-Safe Certified Firm is required for this 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 fill out the RRP
Acknowledgement.
& SAFETY PERMIT/PLAN CHECK APPLICATION
."Menifee
DATE PERMIT/PLAN CHECK NUMBER n2i:qm
TYPE: 0 COMMERCIAL 'IrRESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION OALTERATION ODEMOUTION OELECTRICAL OMECHANICAL
CNEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES-
DESCRIPTION OF WORK - 6,9d pq),4 2'S /t4r,0 -,72-S 31 ;55
1 L)
PROJECTADDRESS -2 %6fl ,FYioh,,ut) vy- 191 Qk4 C,# 725'256
ASSESSOR'S PARCEL NUMBER LOT TRACT --G'ty G ="e"
OWNER NAME Adyirmm 5h Ye,m Building a ty Dept.
ADDRESS 7-%Gql F_riol6inust) Dv NOV 0 1 2016
PHONE _;/0 1 & 35 2� EMAIL
Received
APPLICANT NAME cyidian 03ofio
ADDRESS 5A C,
PHONE EMAIL
CONTRACTOWSNAME �)ol(,105 OWNERBUILDER? OYES >90
BUSINESS NAME
ADDRESS J 'M55 1'4a5Y)0)%'0 AVI 9,.0tolbd6
PHONE JS�� 357 '77, '5_� EMAIL 50/o leefrn'.1-5 coyl�
CONTRACTOWS STATE LIC NUMBER q 7633�o' LICENSE CLASSIFICATION
VALUATION$ 7(Y) SqFT L SQ
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
LI I Y UV MLNI U51NLbb LICENSE NUMBER
UEPAHIMENI DINTRIUUTIUN __ — 7M
N
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP ;01 Ty FF Mr
INVOICE PAIDAMOUNT
AMOUNT W I I %%-S 1 0 CASH 0 CHECK# OCREDITCARD VISAINIC
PLAN CHECK FEES I PAIDAMOUNT I I OCASH "CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 No DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Deportment 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.city,ofmenifee.us Inspection Request Line 951-246-6213