PMT16-03373 City of Menifee Permit No. PMT16-03373
29714 HAUN RD. Type: Residential Electrical
't;KCCELX—> MENIFEE, CA 92586
MENIFEE Date Issued: 10/1312016
P E R M I T
Site Address: 26155 HULL ST, MENIFEE, CA 92585 Parcel Number: 331-020-012
Construction Cost: $1.800.00
Existing Use: Proposed Use:
Description of MAIN PANEL UPGRADE 225A
Work:
Owner Contractor
DONNA DAVIS MYERS ELECTRIC CO
26155 HULL STREET 425 W LA CADENA DR#21
MENIFEE, CA 92585 RIVERSIDE,CA 92501
Applicant Phone:9516628769
MYERS ELECTRIC CO License Number:972274
425 W LA CADENA DR#21
RIVERSIDE, CA 92501
Fee Description Obf Amount($)
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 pernut shall not prevent the building official from thereafter requiring the correcrion of errors in the plans and
specifications or from preventing buillding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menlifee.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_Permit 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 am under provisions of With a licensed contractor(s)pursuant to the Contractors State License Law).
Chapteri)(commencing with section 7000)of Division 3 of the Business and u I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class, r, —10 License No. q7n By my signature below I acknowledge that,except for my personal residence
Expires zp I/)? signature in which I must have resided for at least one year prior to completion of
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
ci 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
this permit is issued. WWW.leaInf0.ca.goy1ulaw.htmI.
Policy If Date
cr I have and will maintain worker's compensation insurance,as required by PROPERTY OWN Ell OR A15THRORIZE15 AGENT
section 3700 of the Labor Code,for the performance of the work for which n 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 building construction.I authorize representatives of this city or county to
Policy Jfqll!�!�-s Expires 2� h above identified property for inspection purposes.
(This section need not to be completed is the permit Is for one-hundred rPR'0PERTY OW a Date
dollars($100)or less � If Ali A.T ;.—D AGENT
o I certify that in the performance of the work for which this permit is issued,
I shelf not employ any persons in any me 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 c,� (11A Date amounts spec�ecl on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS D yes d"15
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or firtu re build Ing
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant req u ire 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 0 Yes &ff.-'
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) 0 Yes ojuia�
OWNER BUILDER DECLARATIONS I have read the Haza rclous Material Information Guide and the SCAQM D
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exem pt 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
Business and Professions Code).Any city or county that requires a permit to
construct,alter,Improve,demolish or repair any structure,prior to its nhlt� Date
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 Contractor's 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
•nd the basis for the alleged exemption.Any violation of Section 7031.5 by residence or ch ildcare facility to be RRP-certifiecl firms and com ply with
•n Applicant for a permit subjects the applicant to a civil pena ltv 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
a 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPXs Renovation Program visit:
compensation,will do( I all of or I )portion of the work,and the structure Is www.epa.goy/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 Low does not apply to an owner of a a 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. a No EPA Lead-Safe Certified Firm is required for this project because:
ci 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