PMT16-02919 City of Menifee Permit No.: PMT16-02919
29714 HALIN RD. Type: Residential Electrical
<ACCEUA—> MENIFEE,CA 92586
MENIFEE Date Issued: 09/0112016
P E R M I T
Site Address: 27580 CAMINO BELLA, MENIFEE, CA Parcel Number: 333-275-034
92585 Construction Cost: $2,500.00
Existing Use: Proposed Use;
Description of MAIN PANEL UPGRADE 200A
Work:
Owner Contractor
RONALD VOGIL MARK NELSON BUILDERS
27580 CAMINO BELLA 13570 ST MARYS AVENUE
MENIFEE,CA 92585 RED BLUFF, CA 96080
Appllcant Phone: 5302005581
JUAN GARCIA License Number: 815898
MARK NELSON BUILDERS
13570 ST MARYS AVENUE
RED BLUFF, CA 96080
Fee Description Qty Amount($
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 buitiding 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 construcrion 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.
AkfIldgPerniff-Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION properlywho builds or improves thereon,and who contracts forthe projects
I herebyaffirm underpenaltVof perjurythat I am underprovisions of with a licensed contractor(s)pursuarittothe ContractonState License Law).
Chapterg(commencing with section 7000)of Division 3 of the Business and a I am exemptfrorn licensure underthe ContractoesState Ucense Lawfor
Professions Code and my license is in full force and effect. the following reason:
Ucense Class Vq-A-t4 a, Uicense No. By my signature below I licknowledge that except for my personal residence
Expires,f W.) 12!��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
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 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 www.IegInfo.ca.gov/caIaw.htmI.
this permit is Issued.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
a I 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 ci By my signature below I certify to each of the following:I am the property
this permit is issued.My workees compensation insurance carrier and 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 enter the above identified property for Inspection purposes.
(This section need not to be completed is the permit is for one-bundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
XI 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 workerrs compensation provisions of Section 3700 of the Labor
Code,lshallfo with comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
0 -T- mixture containing a hazardous material equal to or greater that the
Applicant=421A &1 4 1 —?-- Date amounts specified on the Hazardous Materials Information Guide?
WARNINGMAILURE M SECURE WORKER'S COMPENSATION COVERAGE 15 ci Yes a 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 M 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 District(SCAQM D)?See perm itting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY oYes allo
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) oYes oNc,
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
Contractoes License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable itern(s)(Section 7031.5 aYes a 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 OWNER OR AUTHORIZED AGENT
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 Conbractoes State EPA RENOVATION,REPAIR AND PAINTING(RRP)
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 childca re facility to be RRP-certified firms and comply with
an Applica at for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
o 1,as owner of the property,or my employee with wages as their sole employees.Far mom information about EPA's Renovation Program visit:
compensation,will do I )all of or I I portion of the work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at
not Intended or offered for sale.(Section 7044,Business and Professions I-SOD-424-LEAD(5323).
Code,The Contractor's State License Law does not apply to an owner of a ci An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement Is sold within one year of Firm Certification No.;
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sa le. a No EPA Lead-Safe Certified Firm Is required for this project because:
u 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
"Menifee
DATE
PERMIT/PLAN CHECK NUMBERO%Ank.0 - 0 0�) C(
TYPE: OCOMMERCIAL ORESIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION 4k�ELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES—
DESCRIPTION OF WORK ��c �CrLr f)e�a2le-P, c4e �,J (2q rrA.AQ
UY of Menifee
Buildion & saiQbf pej
PROJEcTADDRESS oporb,-5 SEP 0 f 2016
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME an'Int'l Received
ADDRESS
Q /CA Q I'? C ;t:l
PHONE (5212::,) �,(z$ -6 ZZ:�& EMAIL
APPLICANT NAME 'yocon G2,-,LICC-r--nA
ADDRESS 6 IY=C ",r-r ul >t e , C Pq— C�2-e, IgF-
PHONE &f 01)-7/4- 05 4,4C, EMAIL
CONTRAC�DWSNAME IUCtil< �Ue(150 & '(
I OWNERBUILDER? OYES.Q�NCI
BUSINESS NAME 4&rK 2,,
ADDRESS P—e-A
PHONE 05-�46L EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION C-10
VALUATION$ 2-,4!3(DC) SO FT LSQFT
I-8ELL
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BU51NL55 LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE � GREEN SMIP T� I
INVOICE 1 PAIDAMOUNT �Lo '10 0 CASH 0 CHECK H 0 CREDIT CARD VISA/MC
AMOUNT
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213