PMT16-03558 City of Menifee Permit No.: PMT16-03558
29714 HAUN RD. Type: Residential Electrical
<A- CCELP1;)' MENIFEE, CA 92586
MENIFEE Date Issued: 11/0212016
P E R M I T
Site Address: 29937 GIFHORN RD, MENIFEE, CA Parcel Number: 339-313-002
92584 Construction Cost: $2,000.00
Existing Use: Proposed Use:
Description of INSTALL 200 AMP PANEL UPGRADE
Work:
Owner Contractor
JOHN RODGERS JPE ENTERPRISES INC
29937 GIFHORN RD 4634 VIA LA QUINTA
MEN IFEE, CA 92584 YORBA LINDA, CA 92886
Applicant Phone:7142349040
RAFAEL COBRAL License Number:633319
JPE ENTERPRISES INC
4634 VIA LA QUINTA
YORBA LINDA, CA 92886
Fee Description ON Amount($1
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 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 be
forfeited.
AA BldgPerryfit-Template.ript Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe 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 o I am exemptfrom licensure underthe Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason;
License Class C C2 License No. 62 S By my signature below I acknowledge that,except for my personal residence
Expires Signature " I
in which I must h...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 DECLARATIAZ have built as an owner-builder If it has not been constructed in its entirety by
a 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 ava liable 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.leginfo.ca.goy/calaw.himl.
Policy# 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 o By my signature below I certify to each of the following:I am the property
this permit is issued.My workees compensation insurance carrier and policy owner or authorized to act on the property ownees 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 te C>, al building construction.I authorize representatives of this city or county to
Policy# we W Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-h und red Date
dollars($100)or less PROPERTY OWN ER 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 a ny me nner so as to becom e 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 La bar
Code,I shall fo"h cqmply with those provisions. Will the applicant or future build ing occupa nt handle hazardous materia I or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts spesilled on the Hazardous Materials Information Guide?
WARNING:FAILU'ROE TO SECURE WORKER'S COMPENSATION COVERAGE IS a Yes w1ra
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 HUN DRIED THOUSAND DOLLARS($100,000),IN occupant req uIre 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 guideline
CONSTRUCTION LENDING AGENCY cr Yes JEIo;
I hereby affirm that under the penalty of perjury them is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performa nce of the work which this permit is Issued outer bounj><cf a school?
(Section 3097 Civil Code) 0 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
Contractoes 6cense 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 oYes n No
Business and Professions Code).Any city or county that requires a permit to
construct,a Iter,improve,demolish or repair any structure,prior to its �� 4� —Date 7, /6
issuance,also requires the applicant for the permit to file a signed statement PAOfATY OMER OR AUTHORIZCD—AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING fiRRPl
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 Profe�ssions 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 childcare facility to be RRP-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($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 sale employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is wwvv.epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7D44,Business and Professions 1-800-424-LEAD(532.3).
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 Improvesthe
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 forthis project because:
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 If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
--Menifee
DATE PERMIT/PLAN CHECK NUMBER m*T Ito Ow. b
TYPE: OCOMMERCIAL �01R-ESIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOLISPA OSIGN
SUBTYPE: OADDITION CALTERATION ODEMOLITION Q-MCTRICAL OMECHANICAL
ONEW CIPLUMBING 0 RE-ROOF-NUMBER OF SQUARES_
DESCRIPTION OF WORK
�2
PROJECTADDRESS 7, :7'�` 3 7C kory) 'W c4 A/P-V)J* pep C k: 61 ut
ASSESSOR'S PARCEL NUMBER LOT Tj TRACT ZS7N -10
OWNERNAME _CLdm!I)
ADDRESS C-/4
PHONE EMAIL
APPLICANT NAME ta C-&�U C r.-,( 6 r-as
ADDRESS L-
CA f-) " vi rl,- 14 04
PHONE EMAIL
CONTRACTOR'S NAME 5CV) OWNER R-11 I
,T
BUSINESSNAME
CD C I C',
ADDRESS L4' Qoj'jnf:�L 4L�t L—;Vl ii
PHONE 2-51-1- EMAIL I led r (4 V,-of
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION r)
VALUATION$ C, SQ FT L SQ FT
DATE lk
APPLICANT'S SIGNATURE
07-Y STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP D3(e
INVOICE I IL14. PAID AMOUNT HECK# OCREDITCARD VISA/MC
AMOUNT I 1 0 CASH C
PLAN CHECK FEES! PAIDAMOUNT I I OCASH OCHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Deportment29714 Houn Rd. Menifee, CA 92586951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213