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PMT16-03705 City of Menifee Permit No.: PMT16-03705 29714 HALIN RD. Type: Residential Electrical <A—CCELX--' MENIFEE, CA 92586 MENIFEE Date Issued: 1111712016 P E R M I T Site Address: 26086 SNOW CREEK DR,MENIFEE, CA Parcel Number: 338-271-006 92586 Construction Cost; $500.00 Existing Use: Proposed Use: Description of DERATE MAIN PANEL FROM 125A TO 1 OOA Work: Owner Contractor JOCELYN AMESQUITA PACIFIC GREEN HOMES INC 26086 SNOW CREEK DRIVE 15127 CALIFA STREET MENIFEE,CA 92586 VAN NUYS, CA 91411 Applicant Phone:8183015354 SABA RASHID] License Number: 1008948 PACIFIC GREEN HOMES INC 15127 CALIFA STREET VAN NUYS,CA 91411 Fee Description City Amount Services,Switchboards, Control Centers&Panels 1 116.00 Building Permit Issuance 1 27.00 GREEN FEE 1.00 General Plan Maintenance Fee-Electrical 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_Bldg_Pemit Ternplate.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 contnctor(s)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the contractoes State License Law for Professions Code and my license is in full force and effect. the following reason: Uicense Ciao $ License No. 0091(41 By my signature below I acknowledge that,except for my personal residence Expires signature in which I must have resided for at least one year prior to completion of improvements covered by this permit.I ca nnot legally sell a structu re that I WORKER'S COMPENSATION DECLARATIOW�� 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 workees 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.Ieginfo.ca.gov/calaw.html. Policy# Date a I have and Will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT secrion 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 a m the property this permit is issued.My worker's compensation insurance Carrier and policy owner or a uthorized to act on the property owner's bEha If.I have read this number are; application and the information I have provided is correct.I agree to comply Carrier gork with all applicable city and county ordinances and state laws relating to ........5 Coon.I authorize representatives Of this City Or County to Policy# Expires 47_M_4 enter the above identified property for inspection purposes. — 9T_9",� (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# workees compensation lam of Califomia,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 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 __ T_ amounts specified on the Hazardous Materials Information Guide? WARMMG'FXUR'E TO SECURE WORKERS COMPENSATION COVERAGE IS uYes oft UNLAWFU4 AND SHALL SUBJECr AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building AND CIVIL FINES UP TOONE 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 Ma nagement District(SCAQM D)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST�AND ATTORN EYS FEES forguidelines CONSTRUCTION LENDING AGENCY o 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 mNo OWNER BUILDER DECLARATIONS I have mad 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 oYes n No Business and Professions Code).Anycity or countVthat requiresa permitto 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 Contractoes State EPA RENOVATION,REPAIR AND PAINTING IRRPI 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 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 req uIred 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 propeft or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit: compensation,will do I )all of or I 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 1-80D-424-LEAD(5323). Code;The Contractoes 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,th rough 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. o No EPA Lead-Safe Certified Firm is required for this project because: o 1,as owner of the property am exclusively contracting Vith licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractoes State License Law don not apply to an owner of a If your project don not comply with EPA RRP rule please fill out the RRP Acknowledgement BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION ..""Menifee DATE PERMIT/PLAN CHECK NUMBER P�Mkp -cr6—lns TYPE: 0 COMMERCIAL 04ESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN 0 ,g' 0 MECHANICAL SUBTYPE: 0 ADDITION �ALTERATION 0 DEMOLITION & LEcrRICAL ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES— DESCRIPTION OF WORK (�_2Q +�, PROJEcTADDRESS DJ�Dc) SCO ASSESSOR'S PARCEL NUMBER g1k -L^,a,0 LOT TRAO[ty Ot m9nit" OWNERNAME 36C5�\ \r\ VC�Vy�f�, qp�A-C\._ BulldlnYg saiety 900 ADDRESS !;6W nS PAc6Y-?-- NOV 11 20 PHONE EMAIL R().c _91ved APPLICANT NAME ADDRESS PHONE _211�1 I- EMAIL &_\Q cowmcrogls NAME OWNERBUILDER? OYESCNO BUSINESS NAME j2Ck L( jv-\(_ ADDRESS Ct�-\ PHONE EMAIL 2)F&C\ C CONTRACTOR'S STATE LIC NUMBER JOC�)Z�5tC47 LICENSE CLASSIFICATION _5> VALUATION$ 9:10 SO FT LSQFT APPLICANT'S SIGNATURE— DATE NW, my M, DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP INVOICE 1111MOUNT AMOUNT k14 01-SO %L A-90 I OCASH OCHEO(# OCREDITCARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISAIMC OWNER BUILDER VERIFIED OYES 0 No DL NUMBER NOTARIZED LETTER 0 YES Ow N() City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofmenifee.us Inspection Request Line 951-246-6213