PMT16-02993 City of Menifee Permit No.: PMT16-02993
29714 HAUN RD. Type: Residential Electrical
<ACCELA—> MENIFEE,CA 92586
MENIFEE Date Issued: 0910812016
P E R M I T
Site Address: 27149 SWIFT ST, MENIFEE, CA 92584 Parcel Number: 360-402-017
Construction Cost: $1,800.00
Existing Use: Proposed Use:
Description of MAIN PANEL UPGRADE 125A
Work:
Owner Contractor
TAMARA CRABBE SERVICE TEAM OF PROFESSIONALS TEMECULA
27149 SWIFT STREET 33794 WAGON TRAIN DR
MENIFEE,CA 92584 WILDOMAR, CA 92595
Applicant Phone: 9512461001
KENNY KLOTZ License Number.976252
SERVICE TEAM OF PROFESSIONALS TEMECULA
33794 WAGON TRAIN DR
WILDOMAR,CA 92595
Fee Description City 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 5.80
$149.80
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of emors in the plans and
specifications or from preventing builicling operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherviise 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_Perrnil_Ternplate.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or Improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuantto the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of u 1 am exempt from Hcensure under the Contractor's State License Law for
Chapter9(commencing with section 7000)of Division 3 of the Business and
Professions Code and my license is in full force and effect. the following reason:
License Class e. I C'> License No. '?76Z,5-' By my signature below I acknowledge that except for my personal residence
Expires 'C/MJ/LS Signature in which I must have resided for at least one year prior to completion of
Q-2) improvements covered by this permit.I cannot legally sell 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-insu for worker's 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industria I Relations as provided for this application is submitted or at the following wabsite:
by Section 3700 of the Labor Code,for the performance of work for which www.legInfo.ca.govLcalaw.html.
this permit Is issued. Date
Policy# PROPERTY OWNER OR AUTHORIZED AGENT
irl have and will maintain worker's compensation insurance,as required by ature below I cerftto each of the following:I am the property
section 3700 of the Labor Code,for the performance of the work for which a By my sign owner's behalf.I have read this
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property
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 v-1 oc 4C-7&,X-C building construction.I authorize representatives of this city or county to
zd443 6 000s"( Expires 1/1/17 enter the above identified property for inspection purposes.
Policy# r
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is Issued,
I shall not employ any persons in any ma nner 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 worker's 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
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE�EWORXER`S COMPENSATION COVERAGE 15 o Yes OwNci
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 District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY Dyes itNo
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) o Yes olilo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
p rmitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjurythat I am exempt from the Zifornia Health&Safety Code,Section 25505 and 25534 concerning
Contmctor's License Law for the reason(s)indicated below bythe hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 - oNX
Business and Professions Code).Any city or county that requires a permit to ew 0'
te
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY Ow�R&HORIZED 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 Contractor's State EPA BEN ON,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(1111P)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-certifled 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 a nd 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.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.govllead or contact the National Lead Inforniation Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a n An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,th rough 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 yea r of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was a No EPA Lead-Safe Certified Firm is required for this project because:
not built or improved for the purpose of sale.
a 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 RAP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: 0, COMMERCIAL PRESIDENTIAL 0MULTI-FAMILY CMOBILEHOME POOL/SPA OSIGN
SUBTYPE: )ADDITION OALTERATION ODEMOUTION -eELECTRICAL OMECHANICAL
ONEW " PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK A,&,ra_c�Lo
tj
PROJECTADDRESS 'Z71
ASSESSOR'S PARCEL NUMBER
r)Q-0 t-1 LOT TRACT
OWNERNAME -C t Met ifee
ADDRESS —7,771ttcl dS4Y( BuIldi7g 80, Sak ty Dept.
PHONE q5:(-1176— EMAIL SEP fl R !916
APPLICANT NAME cennef--k V(d-�
ADDRESS meceived
PHONE Cti;j—4g66:-_7 6 e� V� EMAIL
CONTRACTOR'S NAME OWNERBUILDER? OYES �VNO
BUSINESS NAME
ADDRESS
PHONE -qG71-7 60- ?-Z)Z-�� EMAIL
CONTRACTOR'S STATE LIC NUMBER q '76 LICENSE CLASSIFICATION
VALUATION SO FT L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LILENhE NUMbtK
BUILDING PLANNING ENGINEERING FIRE [GREEN 7smcipc ,
INVOICE PAID AMOUNT 0 0 CREDIT CARD VISA/MC
AMOUNT I OCASH OCHECK#
PLAN CHECK FEES PAID AMOUNT I
OCASH C"CHECKII OCREDITCARD ViSA/MC
OWNER BUILDER VERIFIED OYES r' NO DLNUMBER NOTARIZED LETTER 01 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmemfee.us Inspection Request Line 951-246-6213