PMT16-03881 City of Menifee Permit No.: PMT16-03881
29714 HAUN RD. Type: Residential Electrical
<A-CCr-LA—> MENIFEE,CA 92586
MENIFEE Date Issued 12101/2016
P E R M I T
Site Address: 25921 COOMBE HILL DR, MENIFEE, CA Parcel Number., 339-103-017
92586 Construction Cost: $1,000-00
Existing Use: Proposed Use:
Description of UPGRADE SERVICE PANEL TO 200AMPS
Work:
Owner Contractor
LAWRENCE LONG SMITH ELECTRICAL CONTRACTORS INC
25921 COOMBE HILL DR 206 GREENFIELD DR STE G
MENIFEE,CA 92586 EL CAJON,CA 92020
Applicant Phone:6197589829
JANE RECKTENWALD License Number-, 871200
SMITH ELECTRICAL CONTRACTORS INC
206 GREENFIELD DR STE G
EL CAJON, CA 92020
Fee Description Oty 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 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 builicling 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_Permit Template.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 contractor(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 underthe Contractoes State License Law far
Professions Code and my license is in full force and effect. the following reason:
Uicense Class—C-1.0 License No.%-I k D'cx� By my signature below I acknowledge that,except for my personal residence
Expires 1-3 AS 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 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 www.leginfio.ca.gov/calaw.html.
this permit is issued.
policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
o I have and will maintain worker's compensation insurance,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 am the property
this permit Is issued.My workees compensation insurance ca rder 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 with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#110006 LOL40 Expires �0-DOS enter the above identified pro y for inspection purposes.
7py
(This section need not to be completed is the permit Is for cm�hundrexl ale
dollars($100)or less PROPERTY OWN—ER OR t�"ZED AGENT
ci 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#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workees compensat! rovisions of Section 3700 of the Labor
Code,I shall forthwith comply ose provisi ns. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified an the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURF'FIXER'S COMPENSATION COVERAGE IS uYes oNo
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 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,I NTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY oYes nNo
I hereby affinnn 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 allo
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
Contractor's License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable itern(s)(Section 7031.5 ciYes o No
Business and Professions Code).Any city or county that requires a permit to Date
construct,a Iter,impmve,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 Contra ctor's State EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing wiftb Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business a nd Professions code)or that he or she is exempt from ficensure 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 childaure 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 theirsole employees.For more information about EPA's Renovation Program visit:
compensation,will do I )all of or I )portion of the work,and the structure is www.epa.gavllead 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 respomflile 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:
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 sa le. a 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 a n owner of a If you r project does n ot conn p ly with EPA RRP ru le please fill out th e RRP
Acknowledgement.
Jim. W1010010139r-1192%
n i fee e
DATE 12-1-16 PERMIT/PLAN CHECK NUIVIBERTtn(Q- 00:55S I
TYPE: -; COMMERCIAL VRESIDENTIAL .- MULTI-FAMILY C MOBILE HOME ��) POOL/SPA �11 SIGN
SUBTYPE: OADDITION OALTERATION IDEMOUTION VELECTRICAL � MECHANICAL
NEW �_,' PLLIMBING ) RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Upgrade service panel to 200 amps
PROJECTADDREss 25921 Coombe Hill Dr Sun City, CA 92586
ASSESSOR'S PARCEL NUMBER 339-103-017 LOT v2y TRACT Q 6 ql)_
OWNER NAME Lawrence Long
ADDRESS . .25921 Coombe Hill Dr Sun City, CA 92586
PHONE 951-679-3424 ____ EMAIL
APPLICANT NAME Jane Recktenwald
ADDRESS
PHONE 714-336-6159 EMAIL
CONTRACTOR'S NAME Smith Electrical OWNER BUILDER? �� YES AD
BUSINESS NAME Smith Electrical
ADDRESS 206-Greenfield Dr Ste G El Cajon, CA 92020
PHONE 6.19-758-9829 *AX _&Ls.�n s Hicense # 037694
CONTRACTOR'S STATE LIC NUMBER 871200 LICENSE CLASSIFICATION C10
VALUATION $ SO FT LSQFT
APPLICANT'S SIGNATURE DATE 12-1-16
DEPARTMENT DISTRIBUT ION CITY OF MENIFEE BLISIN!SS LICENSE NUMBER
BUILDING PLANNING ENGJ�LEERING PRE GREEN SMIP
INVOICE
AMOUNT PAIDAMOUNT -CASH D CHECK N CREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT CASH � CHECK a 'CREDITCARD VISA/MC
OWNER BUILDER VERIFIED , YES -� NO DLNUMBER NOTARIZED LETTER - YES � NO
Ci�,volrvle;iiii?c!r'3tii�diiifI & SafetyDepo0ment 29711.1 �jaun Rd� CA 92-1,Bf; 951 6,72 6777
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