PMT16-03498 City of Menifee Permit No.: PMT16-03498
29714 HAUN RD. Type: Residential Electrical
<ACCIEO� MENIFEE. CA 92586
MENIFEE Date Issued: 10/2612016
P E R M I T
Site Address: 27260 PALOMA WAY, MENIFEE, CA Parcel Number: 336-011-021
92586 Construction Cost: $1,800.00
Existing Use: Proposed Use:
Description of 200 AMP MAIN PANEL UPGRADE FOR FUTURE SOLAR
Work:
Owner Contractor
THOMASTHOMPSON SERVICE TEAM OF PROFESSIONALS TEMECULA
27260 PALOMA WAY 33794 WAGON TRAIN DR
MENIFEE,CA 92586 WILDOMAR,CA 92595
Applicant Phone:95124610011
KENNETH KLOTZ License Number: 976252
33794 WAGON TRAIN DR
WILDOMAR, CA 92595
Fee Description Qtv Amount($
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 errors 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 within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall he
forfeited.
AA_B1dg_Perrnit-Temp1a(e.rpt Page 1 of 1
I
CITY OF MENIFEE
LICENSED DECLARATION property who builds or Improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapterl;(commencing with section 7000)of Division 3 of the Business and o I am exemptfrom licensure unilerthe Contractor's State License Law for
Professions Code and my license is In full force and effect. the following reason:
License Clan Lt(b license No.'?71Z!;-Z_ By my signature below I acknowledge that,except for my personal residence
Expiresgir A 30 Q 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 entirely 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 wwwJeRInfo.ca.gov/calaw.htm1.
this permit is issued.
Date
Policy# PROPERTY OWNER OR AUTHORIZED AGENT
P:l 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 u 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 e., -k build ing construction.I authorize representatives of this city or county to
PoRcy#'5kL_V_ 6606'�F--t Expires 0117 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 OWNER OR AUTHORIZED AGENT
0 1 certify that in the performance of the work for which this permit is issued, vs 4q�
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE It
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 visions. 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 10/LZ5/6� amounts specified on the Hazardous Materials Information Guide?
WARNING:FAIUJRETO�2C rREWORKER'S COMPENSATION COVERAGE IS n Yes "a
UNLAWFUL,AND SHALL SUBJECr AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FIN ES UP TO ONE HUNDRED THOUSAND DOLLARS($100,ODO),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COM PENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SICTION 3706 OF TH E LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCrION LENDING AGENCY a Yes IQMo
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) a Yes "a
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
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 94es o No
Business and Professions Code).Any city or county that requires a permit to 1&Zi�� —Date 1 D'/-Z5—/J
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER DqU;KORIZED 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 PAINTI G IRRP)
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.Anyviolation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applica nt to a civil pena Ity 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 sale employees.For more information about EPA's Renovation Program Visit:
compensation,will do( )all of or( 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 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,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 o No EPA Lead-Safe Certified Firm is required for this project bemuse:
nut built or improved for the purpose of sale.
cr 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 I f yo ur project d oes n at com p ly with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
W."Menifee
DATE ibl-15-116 PERMIT/PLAN CHECK NU ko orc)"9
TYPE: OCOMMERCIAL .50RESIDENTIAL OMULTI-FAMILY 0MOBILEHOME 0 POOL/SPA r,SIGN
SUBTYPE: OADDITION CALTERATION ODEMOLITION *ELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES_
DESCRIPTION OF WORK (-.,i
PROJECT ADDRESS
00 COL I LOT TRACT
ASSESSOR'S PARCEL NUMBER
OWNER NAME
ADDRESS -L,7Z60
PHONE EMAIL
APPLICANT NAME "P?/ICP11 (6
-53-�j�/
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME L,5h,0tkxN(->,1x�BU�1LDER? 0 YES 0 NO
BUSINESSNAME
ADDRESS
PHONE cf—?.-d EMAIL
CONTRACTOR'S STATE LIC NUMBER T7 6 7-,5'7— LICENSE CLASSIFICATION 64 C)
VALUATION $ (SaD SO FT L SQ FT
APPLICANT'S SIGNATURE ?c DATE I
OTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION ITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP a?,G-349
INVOICE PAID AMOUNT CASH C)CHECK# "CREDITCARD VISA/MC
AMOUNT
PLAN CHECK FEES PAIDAMOUNT OCASH 0,CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYESO No DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofnienifee.us Inspection Request Line 951-246-6213