PMT16-03076 City of Menifee Permit No.: PMT16-03076
29714 HAUN RD.
<A-CCFLA> MENIFEE,CA 92586 Type: Residential Electrical
MENIFEE Date Issued: 09/19/2016
PERMIT
Site Address: 26950 PINEHURST DR, MENIFEE, CA Parcel Number: 33M52-029
92586 Construction Cost: $2,300.00
Existing Use: Proposed Use:
Description of ELECTRICAL SERVICE UPGRADE 10DAMP TO 200AMP
Work:
Owner Contractor
MICHELLE GIBBS RB ELECTRICAL SERVICE
26950 PINEHURST DR 27393 FINALE COURT
MENIFEE, CA 92586 MENIFEE,CA 92584
Appilcant Phone: 9512010116
BRIAN RAINEY License Number:949601
RB ELECTRICAL SERVICE
27393 FINALE COURT
MENIFEE,CA 92584
Fee Description 0y. Amount
Receptacle,Switch,Outlet&Fixture 1 116.00
Building Permit Issuance 1 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 emors in the plans and
specifications orfirom preventing bulliding operations being carried on thereunderwhen in violation ofthe 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.BldgPermit Ternplate.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION propertywho builds or improves thereon,and who contractsforthe 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 Contractor's State License Law for
Professions Code and my license is in full force and effiecL the following reason:
Licens:Class (�— f 1) License No. qq'F(0o By my signature below I acknowledge that,except for my personal residence
Expire -212116V Signature— in which I must have resid ed for at least one year prior to completion of
Improvements covered by this permit.I cannot legally sell a structure that I
.R'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 ma intain 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 apprication 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.leginfo.ca.goy/calaw.htmi.
Policy# Date
1"I have and will maintain worker's compensation insurance,as required by PROPERTY OWN ER OR AUTHORIZED AGENT
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 am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on 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 Waco a.I t'r-a�-Ce- building constrtiction.I authorize representatives of this city or countVto
Policy# Nib B OZ797 I —Expires //7 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 OWN ER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued, ()�&02-1—;�
[shall not employ any persons in anymannersoasto become subject to the CITY BUSINESS LICENSE# 07'y I
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 co ith those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant <' Date !fh q mixture containing a hazardous material equal to orgreater thatthe
tt=:5 I — amouln pecifled on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKEWS COMPENSATION COVERAGE IS n Yes f,rNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the Intended use of the building by the applicant or future building
AN D CIVIL FIN ES 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(SCAQM D)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguldey6fies
CONSTRUCTION LENDING AGENCY o Yes 0 No
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 b d ry of a school?
07"a
(Section 3097 Civil Code) a Yes No
OWNER BUILDER DECLARATIONS I have mad 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 h dous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 7er o No
Business and Professions Code).Anycity orcountythat requires a permitto Z�1� Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY 6WNWOR AOTHORIdD AGENT
issuance,also requires the applicant for the permit to Me a signed statement
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRPJ
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 pre4978
and the basis for the alleged exemption.Any Violation of Section 7031.5 by residence or childcare facility to be RRP-certffied firm 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
a to 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.goy/lead or contact the National Lead Information Center at
not intended or offered forsale.(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,th tough em ployees'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. a No EPA Lead-Safe Certified Firm is required for this project because:
n 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business a nd Professions
Code:The Contractoes 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
1,
DATE PERMIT/PLAN CHECK NUMBER *PM110
TYPE: OCOMMERCIAL ARESIDENTIAL OMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION KELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK ( 4�rrj( IbOA- 4 Z oz)A
PROJECTADDREss Z)r
ASSESSOR'S PARCEL NUMBER LOT (0'7 TRACT Q403
OWNERNAME k&!L6,lu Gk6b5
ADDRESS a29(b Plwlk"-� --ibf- sv-, 0j%l-,f co-
PHONE 9q I Z75— e?,3 3�— EMAIL Aj Itt
APPLICANT NAME gr 12 1c,�14
ADDRESS 273fl ienf�b U- '
PHONE M/ :06(o I �k EMAIL
CONTRACTOWS NAME OWNERBUILDER? OYES�/NO
BUSINESS NAME -7
ADDRESS -7�?�'3
PHONE ?E/ 2 0 t 6 11 4� EMAIL
CONTRACTOR'S STATE LIC NUMBER 7W661 LICENSE CLASSIFICATION —C- 1`6
VALUATION$ SQ FT L SO FT
APPLICANT'S SIGNATURE DATE
lw m
DEPARTMENT DISTRIBUTION CITY OF M6FEE EILAMLESS LLCEU5E NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN fie SMIP 7�:)
INVOIC�E
T 0 CASH 0 CHECK# OCREDITCARD VISA/Mc
AMOUN HOOD PAIDAMOUNT
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISAIMC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZED LETTER
City of Nlenifee Building ge Safety Deporti-rient 29714 Houn Rd. Menifee. CA 92586 951-672-6777
www.cityofmenifee,us Inspection Reqoesr Line 951-246-6213