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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 &�; tj --------------1� ----------------- GARAGE /LECTRICAL PANEL -3UI XNCI SAFETY DEPAR" MIENT J M NiFEE DRIVEWAY 40VAL Kp loolp—A20.1 R E\ nail: SIDEWALK '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