PMT16-03626 City of Menifee Permit No.: PMT16-03626
29714 HAUN RD.
-5A-CCF-:LA-> MENIFEE, CA 92586 Type: Residential Electrical
MENIFEE Date Issued: 11/0812016
P E R M I T
Site Address: 28841 LOIRE VALLEY LN,MENIFEE. CA Parcel Number: 364-124-015
92584 Construction Cost: $1.800.00
Existing Use: Proposed Use:
Description of MAIN PANEL UPGRADE 225A
Work:
Owner Contractor
TOM CASSIDA MYERS ELECTRIC CO
28841 LOIRE VALLEY LANE 425 W LA CADENA DR#21
MENIFEE, CA 92584 RIVERSIDE, CA 92501
Applicant Phone:9516628769
RAQUEL VASQUEZ License Number 972274
MYERS ELECTRIC CO
425 W LA CADENA DR#21
RIVERSIDE,CA 92501
Fee Description City Amount I$)
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 enors in the plans and
specifications or from preventing builicling operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Marilee.Except as otherMse 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.BldgPermit-Template.rpt 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).
Chapter!)(commencing with section 7000)of Division 3 of the Business and a I a in exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
LicenseClass A %vj lcuk(a, License I No. NOCYA25`5 By my signature below I acknowledge that,except for my personal residence
Expires(5 1-2,b I�� -Signature 41020 e 4 1 0 k/A Lo�� in which I most have resided for at least one year prior to completion of
WORKER'S COMPENSAT10-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 th a 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 wwvv.Ieginfo.ca.gov/calaw.htmI.
this permit is issued.
Policy# Date
,,91 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 worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
num her are: application a nd the information I have provided is correct I agree to comply
with a 11 applicable city and county ordinances and state laws relating to
Carrier k-k A�Fz e'\k6 w um ni ce oolm PeLM( building construction.I authorize representatives of this city or county to
Policy# m�\/1)GCR()002 p'ires; 6//_3L I I-? enterthe 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
a 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 it
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workees compensation provisions of Section 3700 of the Labor
Code,ishalifo hwith comp Y with thoseiprovisions. Will the applicant or future building occupant handle hazardous material or a
-76 1 mixture containing a hazardous material equal to or greater that the
Applica ORT Date7 Az/i r. amounts speCifted on the Hazardous Materials Information Guide?
WARNING:FAILLI&E TO SECURE WORKER'S COMPENSATION COVERAGE IS o 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 CoastAir Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY in Yes o 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) oYes ONO
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 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 uYes; o 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 Contnictor's State EPA RENOVATION,REPAIR AND PAINTING IRRPJ
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 a Ileged 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 pena Ity of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves orthrough their
Ei 1,as owner of the property,or my employee with wages as their sole employees.For more Information about EPXs Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is wwwepa.goy/lead or contact the National Lead Information Center at
not Intended or offered for sale.(Section 7044,Business and Professions 1-80D-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:
sa le.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 sa[a. 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 PAT rule please fill out the RAP
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE 11/7/16 PERMIT/PLAN CHECK NUMBER
TYPE: 000MMERCIAL (XRESIDENTIAL OMULTI-FAMILY OMOBILEHOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION OALTERATION CDEMOLITION O(ELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
ol=tffee
DESCRIPTION OF WORK (N) 225A Main Panel R i j I I dCin"a a V Dept.
NOV 9 8 2016
PROJECTADDRESS 28841 Loire Valley Lane CGCSU
ASSESSOR'S PARCEL NUMBER LOT TRACTReceived
OWNER NAME Tom Cassida
ADDRESS 28841 Loire Valley Lane
PHONE EMAIL
APPLICANT NAME Holly Thompson
ADDRESS 710OWFloridaAve
PHONE 951-537-6859 EMAIL holly.thompson@horizonsolarpower.com
CONTRACTOR'S NAME OWNERBUILDER? 0YES ,4tNO
BUSINESS NAME Myers Electric
ADDRESS 425WLaCadenaDr# 21
PHONE 951-662-8769 EMAIL
CONTRACTOR'S STATE LIC NUMBER 917274 LICENSE CLASSIFICATION C-10
VALUATION$ 1,800.00 SO FT L SO FT
APPLICANT'S SIGNATURE DATE 11/7/16
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE , GREEN SMIP I
INVOICE PAID AMOUNT 0 CASH 0"CHECK# CICREDITCARD VISA/MC
AMOUNT 1141. w I I I
'PLAN CHECK FEES PAID AMOUNT 0 CASH C CHECK# OCREDITCARD VISA/MC
[O�WNIEBUILDER VERIFIED 0 YES 0, NO DILNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213