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PMT16-03432 City of Menifee Permit No. PMT16-03432 29714 HAUN RD. Type: Residential Electrical <A-CCr--6�' MENIFEE,CA 92586 W.— MENIFEE Datelssued: 1011912016 P E R M I T Site Address: 28195 DAKOTA DR, MENIFEE,CA 92587 Parcel Number: 350-052-019 Construction Cost: $1,500.00 Existing Use: Proposed Use: Description of ELECTRICAL PANEL UPGRADE TO 200 AMP FOR FUTURE SOLAR Work: Owner Contractor LEO MARTINEZ WEST COAST APPLIANCE SERVICES INC 28195 DAKOTA DR 1256 FAYETTE STREET MENIFEE, CA 92587 EL CAJON,CA 92020 Applicant Phone:6195570446 LEO GENDELMAN License Number:810930 WEST COAST APPLIANCE SERVICES INC 1256 FAYETTE STREET EL CAJON, CA 92020 Fee Description P!X Amount W Receptacle,Switch, Outlet&Fixture 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 emors 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 Wthin 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.81dg_Perrnit Template-rpt Page 1 of 1 CITY OF MENIFEE property who builds or improves thereon,and who contracts for the projects LICENSED DECLARATION with a licensed contractor(s)pursuaritto the Contractors State License Law). I hereby affirm under penalty of perjury that I am under provisions of ct I am exempt from licensure under the Contractor's State License Law fat Chapter9(commencing with section 7000)of Division 3 of the Business and the following reason: P rofessions Code and my license Is in full force and effect. License Class G'(C) -__Uceh4N6- By my signature below I acknowledge that,except for my personal residence in which I must have resided for at least one year prior to completion of Expires 0? t /9 Signature 1---el improvements covered by this permit.I cannot legally sell a structure that 1 WORKER'S COMPENSATION DECLARATION have built as an owner-builder If it has not been constructed in its entirety by If the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section o I hereby affirm under penalty of perjury one o is available upon request when haw and will maintain a certificate of consentof self-insure for worker's 7044 of the Business and Professions Code, 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.Iegmfo.ca.RovLCaIaw-htmI- this permit is issued. Date� Policy# P&0442R�_ PROPERTY OWNER OR AUTHORIZED AGENI d4ave and will maintain worker's compensation insurance,as required by ci By my signature below I certify to each of the following:I am the property section 3700 of the Labor Code,for the performance of the work for which owner or authorized to act an the property owner's behalf.I have read this this permit is issued.My worker's compensation insurance carrier a nd policy application a nd the information I have provided is correct.I agree to comply number are: 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#WC001 7_L0q_6_6_FxpIres 0 0/ enter the above identified property for inspection purposes. (ibis section need not to be completed is the permit Is for one-hundred Date dollars($100)or less PROPERMTY NER OR AUTHORIZED AGENT o I certify that in the performance of the work for which this permit is issued, CITY BUSINESS LICENSE If I shall not employ any persons in any manner so as to become subject to the worker's compensation laws of California,and agree that if I should become �HAZARDOUSMATERIAL DECLARATION subject to the worker's co risation provisions of Section 3700 of the Labor Will the applicant or future building occupant handle hazardous material or a Code,I shall forthwit co ith those provislons6 mixtu re containing a hazardous material equal to or greater that the Date. IIJX2 46 amounts specified on the Hazardous Materials Information Guide? Applicant I _wARNING-.FAILU RE TO SECURE WORKERS COMPENSATION COVERAGE Is a-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 To ONE HUNDRED THOUSAND DOLLARS 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 for guidelines alKes a No CONSTRUCrION LENDINGAGENCY Will the proposed building or modified facility be within 1000 feet of the I hereby affirm that under the penalty of perjury there Is a construction outer boundary of a school? lending agency for the performance of the work which this permit Is issued 6-<es ci No (Section 3097 Civil Code) I have read the Hazardous Material Information Guide and the SCAQMD OWNER BUILDER DECLARATIONS permitting checklist.I understand my requirements under the State of 25505 and 25534 concerning I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section Contractor's License Law for the reason(s)Indicated below by the hazardous material rgortins. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 dyirs 0 Vate Business and Professions Code).Any city or county that requires a permit to construct,alter,improve,demolish or repair any structure,prior to its 2 issuance,also requires the applicant for the permit to file a signed statement EPA FATION REPAIR AND PAINTING IRRPI that he or she is licensed pursuant to the provisions of the Contractor's State _ R.EN0VMKAWur-' 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 Hcensure 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-certifled firms and comply with an Applicant for a permit subjects the applica nt to a Civil penalty of not more required practices.This includes rental property owners and property managers who do the paint-disturbing work themselves or through their than($500). .For more information about EPA's Renovation Program visit: cr 1,as owner of the property,or my employee with wages as their sole employees onal Lead Information Center at compensation,will do( I all of or( )portion of the work,and the structure is www.epa.goy/lead or contact the Nati not intended or offered for sale.(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 a An EPA Lead-Safe Certified Renovator will be responsible for this project property who,through employees'or personal effort,builds or improves the Certified Firm Name: property provided that the improvements are not intended or offered for sale.if,however the building or improvement is sold within one year of Firm Certification No.: completion,the�wner-Builder will have the burden of proving that it was ci No EPA Lead-Safe Certified Firm is required for this project bemuse: 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 RRP rule please fill out the RRP Acknowledgement. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION ........... Menifee OCT 19 2016 DATE 10/17/2017 PERMIT/PLAN CHECK NUMBER 'vqwwv , TYPE: [-]COMMERCIAL [2]RESIDENTIAL [-]MULTI-FAMILY E]MOBILEHOME []POOL/SPA El SIGN SUBTYPE: [:]ADDITION r-JALTERATION []DEMOLITION [Z]ELECTRICAL [:]MECHANICAL N EW -1 RE-ROOF-NUMBER OF SQUARES OPLUMBING F - DESCRIPTION OF WORK ELECTRICAL PANEL UPGRADE TO 200 AMP PROJECTADDREss 28195 DAKOTA DR MEN IFEE,CA 92587 ASSESSOR'S PARCEL NUMBER LOT Iq TRACT PROPERTY OWNER'S NAME LEOMARTINEZ ADDRESS 28195 DAKOTA DR MENI FEE,CA 92587 PHONE (951)553-3215 EMAIL fb.wcas@gmaii.com APPLICANT NAME LEO GENDELMAN ADDRESS 1256 FAYETTE ST EL CAJON,CA 92020 PHONE (619)557-0446 EMAIL ftwcas@gmail-com CONTRACTOR'S NAME ALEX PODKOZHURNIKOV OWNERBUILDER DYESZNO BUSINESSNAME WESTCOASTSOLAR ADDRESS 1256 FAYETTE ST EL CAJON,CA 92020 PHONE (619)557-0446 EMAIL fb.wcas@gmaii.com CONTRACTOR'S STATE LIC NUMBER 810930 LICENSE CLASSIFICATION CIO,C20 VALUATION$ 1430 L SO FT _Rr �10/17/2017 APPLICANT'S SIGNATURE �j A CITY STAFF USE ONLY DEPARTMENT DISTRI BLI I 1UN OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN ( IP 0'5'7c>clD PAIDAMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC OWNER BUILDER VERIFIED 0 YES 0 No DL NUMBER NOTARIZED LETTER 0 YES 0 NO City of Menifee Building&Safety Deportment 29714 Houn Rd. rwenife", CA 92586 951-672-6777 www.cityofmenifee.us Inspection Request Line 951-246-6213