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PMT16-03782 City of Menifee Permit No.: PMT16-03782 29714 HAUN RD. Type: Residential Electrical 'tXCCIELA> MENIFEE, CA 92586 MENIFEE Data Issued: 11/22/2016 P E R M I T Site Address: 28079 GROSSE POINT DR, MENIFEE, Parcel Number: 337-031-016 CA 92666 Construction Cost: $3,225.36 Existing Use: Proposed Use: Description of MAIN PANEL UPGRADE 200A Work: Owner Contractor JULIE DOSIER D E C SERVICES INC 28079 GROSSE POINT DRIVE 25695 JEFFERSON AVENUE#17 MENIFEE, CA 92586 MURRIETA, CA 92562 Applicant Phone:9512005262 GABRIEL LIVELY License Number.872782 D E C SERVICES INC 25695 JEFFERSON AVENUE#17 MURRIETA, CA 92562 Fee Description Qtv 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 officiial 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.Bldg_Perrn11—Template.rpt Page I of 1 CITY OF M ENIFEE 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 contrectors)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from Rcensure under the Contractor's State License Law for Professions Code and my license is in full form and effect. the following reason: License Class C - I L) License No. 12--7 5' By my signature below I acknowledge that,except for my personal residence Expires U3 I 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 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 70"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.Ieginfa.ca.goy/mIaw.html. policy# W C-0 Date ri 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 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 Carrier Wt*-S�� I C�A Cz /_�yv��O.-I\L-) with all applicable city and county ordinances and state laws relating to W �'z: building construction.I authorize representatives of this city or county to Policy If '30-25 Expires enterthe above identified propertyfor inspection purposes. (This section need notto be completed Isthe permitis forone-hundred Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT o I certifythat inthe performance of the workforwhich this permit isissued, I shall not empl any persons in any manner so as to become subjectio 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 Labor Code,I shall forthwith c ply with th proA.sions. Will the applicant or future building occupant handle hazardous material or a Applicant Date I 'i mixture containing a hazardous material equal to or greater that the amounts specified an the Hazardous Materials Information Guide? WARNING:FAILURE 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 th e bu ild Ing by the applica nt or future building AN D CIVIL FINES UP TO ON E 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 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines 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) 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 oYes a 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 JRRPI 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 required practices.This includes rental property owners and property than($500). managers who do the paint-disturbing work themselves 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 I )all of or( )portion of the work,and the structure is www.epa.govllead or contact the National Lead Information Center at not intended or offered forsale.(Section 70",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,bu ilds 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 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. DATE PERMIT/PLAN CHECK NUMBER TYPE: EICOMMERCIAL EIRESIDENTIAL []MULTI-FAMILY [-IMOBILEHOME []POOL/SPA EISIGN SUBTYPE-. opum-RON 00,LTERPmON, (3()EMGLMO" ZELEcTRkCAL DMECRARICAL. El NEWEIPLUMBING [-IRE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK A P�UepAe cd DrL+W +6 9-D-S12-00nqaAo City of menjfee j Tw ing & Safety Dep PROJECTADDRESS OV 2 2 2016 ASSESSOR'S PARCEL NUMBER LOT TRACT c)C v di PROPERTY OWNEWS NAME ADDRESS rj>V. 9 Ce P H 0 N E EMAIL CDM APPLICANT NAME -X99 ADDRESS 0 C� 2,:j7 U-Z— PHONE ( �L EMAIL v CONTRACTOR'S NAME OWNER BUILDER7 E]YESZNO BUSINESS NAME C- Sexvic-tc, :Dl:�fi ZilfeJ elf'(4Vif -('nMr)fj1n1T ADDRESS 'DS�V'IS J�gevzW PHONE (t2j q� �1-0 0- 4�;-2-(o EMAILTR�@ diIve GR IlLh:i cto �a hA CONTRACTOR'S STATE JC NUMBER LICENSE CLASSIFICATION (.710 VALUATION$ III FT L SO FT APPLICANT'SSIGNATURE C 4�E��TE J U DEPARTMENT DISTRIBUTION C17Y OF MENIFEE BUSINESS UCENSE NUMBER C ,PFEU 9UU,OM P�WG ONGWEEMLNG FIRE )e AINVOICE PAIDAMOUNT Mo�� U NT M CASH OCHECK# OCREDITCARD VISNMC PLAN CHECK FEES PAIDAMOUNT CCASH OCHECK# ---CREDITCARD VISAJMC OWNER BUILDER VERIFIED 0YES 0 NO OL NUMBER NOTARIZED LEFTER Q YES -- NO City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee,CA 92586 951-672-6777 www.cityofmenifee,us Inspection Request Line 951-246-6213