PMT16-03904 City of Menifee Permit No.: PMT16-03904
29714 HAUN RD. Type: Residential Electrical
<A—CClE1:A'? MENIFEE,CA 92586
MENIFEE Date Issued: 12/02/2016
P E R M I T
Site Address: 28732 ESCALANTE RD, MENIFEE, CA Parcel Number: 351-271-002
92587 Construction Cost: $250.00
Existing Use: Proposed Use:
Description of RUN 65 L FT OF ELECTRICAL LINE THROUGH ATTIC FOR ELECTRICAL GFCI OUTLET FOR PATIO
Work: AREA
Owner Contractor
ANGEL&CHRISTOPHER KEELER
28732 ESCALANTE RD
MENIFEE, CA 92587
Applicant License Number.
MENIFEE, CA
Phone: 9519031599
Fee Description -q!X 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 builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except asotherwise 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
forrelted.
AkBidgPenit-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 a I am exempt from ficensure under the Contractor's State Uicense Law for
Professions Code and my license is in full force and effect. the following mason;
License Class License No. By mysignature 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 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
a 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 www.1eginfo.ca.goy/ca1aw.html.
this permit is issued.
Policy# Date
ci 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 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
number are: application and the information I have Provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
ove
Policy# Expires enter the ab.7'den ified pr erty for inspection purposes.
-hundred
(This section need not to be completed is the permit is for one Date
dollars($100)or less hWdWNER OR AUTHORIZED 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 H.AZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith complywith those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to orgreater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ciYes ciNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER M CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UPTID 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,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ci Yes a 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) 0 Yes 0 No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCACfMD
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 item(s)(Section 7031.5 oYes a No
Business and Professions Code).Any city or county that requires a permit to Date
construct,after,improve,demolish or repair any structure,priorto 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 IRRP)
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
a nd the basis for the alleged exemption.Any violation of Section 7031.5 by residence Or childcare facility to be RRP-certified firms a nd comply with
a n 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 or through their
ci 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.Rov/Iead 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 a 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:
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. ci No EPA Lead-Safe Certified Firm is required for this project because:
ci 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 role please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
M e n i f e e
volP
DATE PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL AESIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION /),ELECTRICAL 0 MECHANICAL
CNEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK C)C
Cw�
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
-!!Z7 -5 L
ADDRESS a &�� t:s�� --
PHONE q5_j EMAIL
APPLICANT NAM&� r
ADDRESS (?e)�
PHONE
EMAIL
CONTRACTOWS NAME OWNER BJILDE Y]E�Q
BUSINESS NAME
ADDRESS 190�-2'3 L4Z&_ �!s
PHONE q,51-7-56 - J��q"S EMAIL
CONTRACTOWS STATE LIC NUMBER LICENSE CLASS111 ATION7C_1
VALUATION$ L So.
L SO FT
APPLICANT'S SIGNATURE
a - &I
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING EwNEERiNG FIRE GREEN SMIP
INVOICE I
AMOU T PAID AMOUNT CASH ()CHECK# OCREDITCARD VISA/MC_
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
[OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER 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
BACKYARD
PATIO
City of Menifee
z GFCI OUTLET uilding & Safety DePt.
DEC 0 2 2016
�,ecelved
DWELLING
A me
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'App. IT 't-d to F
approval ols,any violation of any ;M� A the federal,state or city
must be kert on t4P
regulations and ordinances. TN-&TS&XN*R"Dn.SQUAIL VALLEY 92587
jobsite unfil rOm "lin. STREET