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PMT16-03557 City of Menifee Permit No.: PMT16-03557 29714 HALIN RD. Type: Commercial Electrical <A-CCELA MENIFEE, CA 92586 MENIFEE Date Issued: 1112212016 P E R M I T Site Address: 30519 LONE PINE DR, MENIFEE, CA Parcel Number: 92584 Construction Cost: $500.00 Existing Use: Proposed Use: Description of TEMP POWER-1 200 AMP LI/G METER POLE Work: Owner Contractor WOODSIDE HOMES OF CA BOLD ELECTRIC INC 11870 PIERCE ST#250 2760 PROSPECT STREET RIVERSIDE, CA 92505 CORONA, CA 92881 Applicant Phone:9093403573 FRANK DANIEL License Number.566067 2760 PROSPECT STREET CORONA, CA 92881 Phone:9514535064 Fee Description Qtv Amount Services, Switchboards, Control Centers&Panels 1 183.00 Building Permit Issuance 1 27.00 Additional Plan Review Building 148 148.37 GREEN FEE 1 1.00 General Plan Maintenance Fee-Electrical 1 9.15 $368.62 The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errom in the plans and specifications or from preventing building 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 be forfeited. AA,_Bldg_Permit_Tennplate.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). Chapter9(commencing with section 7000)of Division 3 of the Business and ci I am exempt from licensure under the Contractors State License Law for Professions Code and my license is in full force and effecl� . the following reason: License Class(Z-- I Q) License No.gs-(�LQ By my signature below I acknowledge that,except for my personal residence Expires 14—3��- I I Signature _i�� in which I must have resided for at least one year prior to completion of WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I have built as an owner-builder if it has not been constructed in its entirety by o 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.IeginFc.ca.govJcalaw.htmI. Policy# S�A, _1 C_ Lk-I `�, Date a I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which ci By my signature below I certify to each of the following:I am the property this permit is issued.My worker's co ensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this numberare: application and the information I have provided is correct.I agree to comply Carrier with all applicable city and county ordinances and state laws relating to Policy It building construction.I authorize representatives of this city or county to Expires 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 o I certify that in the performance of the work for which this permit is issued, I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# workerjs 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 sh comply with those provisions Will the applicant or future building occupant handle hazardous material or a Applicant Date mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ci Yes o No UNLAWFUL,AND SHALLSURJECTAN 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($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(SCAQMD)?See permitting checklist IN SECTION 3706 OFTHE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY ci Yes ci 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 boundary of a school? (Section 3097 Civil Code) o Yes o No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD permitting checklist.I understand my requirements underthe 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 ciYes ci No Business and Professions Code).Any city or county that requires a permit to Date construct,alter,improve,demolish or repair any structure,prior to its 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 JRRP) 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.Any violation of Section 7031.5 by residence or chiidcare facility to be FIRP-certified firms and comply with an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property than($SOO). managers who do the paint-disturbing workthemselves orthrough their o 1,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.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 o 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. ci No EPA Lead-Safe Certified Firm is required for this project because: o 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 Men ifee DATE PERMIT/PLAN CHECK NUMBERFetuo- o ,5%-7 TYPE: 0 COMMERCIAL 0 RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN SUBTYPE: OADDITION OALTERATION 0DEMOUTION OELECTRICAL OMECHANICAL CNEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES- 7 DESCRIPTION OF WORK PROJECTADDRESS Fovt ASSESSOR'S PARCEL NUMBER LOT TRACT OWNERNAME ADDRESS 50AI CA' PHONE EMAIL APPLICANT NAME ADDRESS W0:5>PCC—�_ -.Z) CO r) 4' CAk PHONE EMAIL e_k454rj�- CONTRACTOR'SNAMT �nL_\-) OWNERBUILDER? 0 YES VO BUSIN��V\ DCV_)'1C\S ADDRESS ;�-JL�, is PHONE (fA�S\_ " EMAIL CONTRACTOR'S STATE LIC NUMBER SLL��C;� LICENSE CLASSIFICATION VALUATION$ SQ FT LSQFT APPLICANT'S SIGNATURE DATE CITYSTAFF USE ONLY BUILDING PLANNING gGINEERING FIRE GREEN SMIP CITY OF MENIFEE BUSINE ICENSE NUMBER DEPARTMENT 015TRIBUTION INVOICE AMOUNT PAIDAMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISAINIC OWNER BUILDER VERIFIED C)YES 0 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.cityojmenifee.us inspection Request Line 951-246-6213 Mg i Ig 'L�j IM 7; rn it r.L n rn 51 S-, rn 9 C3 15. rn w CL rn r &A rn Fri 16 z rn m C" a3 ao CD I< C= co CD ID 03 O(D ID L�j LA NOW 0 &CL Efl E] (D -]K ID IK -7 0. 0 F3 =So - -- - -C l< �� o nro & �, z - 3 > 0 Lill al L) n m 3 4. 3 7 rs I