PMT16-03851 City of Menifee Permit No. PMT16-03851
29714 HAUN RD. Type: Residential Electrical
MENIFEE, CA 92586
SA—, MENIFEE Date Issued 12/1912016
P E R M I T
Site Address: 26639 MEHAFFEY ST, MENIFEE,CA Parcel Number: 335-282-008
92586 Construction Cost: $1,000.00
Existing Use: Proposed Use;
Description of 200 AMP PANEL UPGRADE FOR SOLAR PERMIT PMT16-03850
Work:
Owner Contractor
CHRISTINA HOLLAND PEAK POVVER SOLUTIONS INC
26639 MEHAFFEY ST 1542 EDINGER AVENUE SUITE D
MENIFEE, CA 92586 TUSTIN, CA 92780
Applicant Phone:7142583900
HENRY AFFRE License Number:973253
1542 EDINGER AVENUE SUITE D
TUSTIN, CA 92780
Fee Description Qtv Amount
Receptacle,Switch. Outlet&Fixture 1 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Electrical 1 &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 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).
Chapter9(commencing with section 7000)of Division 3 of the Business and o I a m 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:
License Class 5 c.pns,e No. 6(_1 3 By my signature below I acknowledge that except for my personal residence
Expires 17- -3 1 , ha SignatukA--�� in which I must have resided for at least one year prior to completion of
�%J 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 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.IeAinIo.ca.goy/calaw.htmI.
Policy# Date
r6ahave and will maintain worker's compensation insuran PROPERTY OWNER OR AUTHORIZED AGENT
L ce,as required by
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 a m 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
numberare: application and the information I have provided is correct.I agree to comply
with all applicable city a nd county ordinances and state laws relating to
Carrier G R-49 t )I--r- building construction.I authorize representatives of this city or cou nty to
Policy# 0 1 P- C)o 2-2—q Expires 7 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-h undred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
c;I certify that in the performance of the work for which this permit is Issued,
Ishalinotemplo any persons in any manner so as to become 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 Laboi
Code,I s rt ith comply)uith se provisions. Will the applicant or future building occupant handle hazardous material or a
I f)5� Date mixture cantaininga hazardous material equal to or greater that the
Ap. t1l, !M= amounts specified on the Hazardous Materials Information Guide?
WARNING:Fjktl�;RE i6`SECURE WORKERS COMPENSATION COVERAGE IS ciYes dNo
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($100,000),IN
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
forguldelines
CONSTRUCTION LENDING AGENCY o Yes '0 No
I hereby affirim that under the pena Ity 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) ci Yes )zi'ho
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQNID
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understap.1 my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 2S505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous mated I rt,
Business and Professions Code).Any city or county that requires a permit to /1"Yes Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWMF:Olk�AUTHOAIZED 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(FIRM
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 lleged exemption.Any violation of Section 7031.5 by residence or childca re facility to be RAP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required pracfice�s.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 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.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 ci An EPA Lead-Safe Certified Renovator will be responsible forthis 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. a No EPA Lead-Safe Certified Firm is required forthis project became:
a 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractoes 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