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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