PMT16-04365 City of Menifee Permit No.: PMT16-04365
29714 HAUN RD. Type: Residential Electrical
<A-CCELA—> MENIFEE, CA 92586
MENIFEE Date Issued: 12/2712016
P E R M I T
Site Address: 25710 HOLLAND RD, MENIFEE, CA Parcel Number: 358-100-006
92584 Construction Cost: $100.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 100A MAIN PANEL WITH NEW 100A MAIN PANEL
Work:
Owner Contractor
SHEILA THORNBURGH CARRIAGE HOUSE SERVICES GROUP INC
24575 HAYRAKE 1805 W CARRIAGE DRIVE
WILDOMAR,CA 92595 SANTA ANA,CA 92704
Applicant Phone: 7149252474
CHRIS DENNY License Number.830758
CARRIAGE HOUSE SERVICES GROUP INC
1805 W CARRIAGE DRIVE
SANTA ANA,CA 92704
Fee Description Qtv Amount
Services, Switchboards, Control Centers& Panels I - 116.00
Meter Reset 1 116.00
Building Permit Issuance 1 27.00
General Plan Maintenance Fee-Electrical 1 11.60
$270.60
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.B1dg_Pemt—Temp1ate.rpt Page I 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 Divls�6P 3 of the Business and o I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force a the following reason:
License Class /3 11 Licensr'6'Zi36 7 S V
By my signature below I acknowledge that,exceptfor my personal residence
Expires 1J3JJ'Z0%7 Signature in which I must have resided for at least one year prior to completion of
Kly I Improvements covered bythis permit.I cannot legally sell a structurethat 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/ f 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 WOnker'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.leginfo.ca.gov/calaw.htmi.
Policy# Date
0 1 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
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# Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
�I certify that In the performance of the work for which this permit is issued,
�Ilhall 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 worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
'156 "JC
Applicant eAW D6,iv,!�t Date 77 OC-6 mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes o No
UNLAWFUL,AND SHALL SUBJECTAN 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
for guidelines
CONSTRUCTION LENDING AGENCY cr 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) a Yes o No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable ftern(s)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to ciYes o No Date
construct,alter,Improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permitto file a signed statement
that he or she Is licensed pursuant to the provisions of the Contractoes State EPA RENOVATION,REPAIR AND PAINTING(RRP)
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)orthat 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-certifled firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more
than($500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
in 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( )all of or( )portion of the work,and the structure is �yww.epa.goylleacl or contact the National Lead Information Center at
nut 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 he 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. o No EPA Lead-Safe Certified Firm Is required forthis 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBERRAme - OL4-&P!s
TYPE: 0 COMMERCIAL a4kRESIDENTIAL CMULTI-FAMILY &OBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: 0 ADDITION 0 ALTERATION 0 DEMOLITION ALECTRICAL 0 MECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBEIR OF SQUARES
DESCRIPTION OF WORK )K,*ij (.j
PROJECTADDRESS IZO c4c c� 0,Qe04
URY Of Menifee
ASSESSOR'S PARCEL NUMBER LOT TRACT Building&Safety De)t.
OWNERNAME '54eAIA -r-jA-,--zw&2nA DEC 2 7 2016
ADDRESS zel S-7�; t+L4/z4ker
PHONE .7,q qz5- zq-7��I EMAIL Received
APPLICANTNIAME Cj+ //�C--
ADDRESS 1-v
PHONE 7/q q zs�- z-e/7�� EMAIL
CONTRAcroWSNAME C?456; (IVC- OWNERBUILDER? 0YES)4NO
BUSINESS NAME
ADDRESS lka�r ou,
PHONE ?le( 'Ft�2-16t7C/ EMAIL
CONTRACTOR'S STATE LIC NUMBER 4�;�o LICENSE CLASSIFICATION
VALUATION$ SO LSQFT
DATE -ck�z 7 20A6
OTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION SM,P CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE REEN
INVOICE PAID AMOUNT
AMOUNT ca'70. U 0 1 I.—nn -Loo , CASH 0 CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT I I CASH 0 CHECK# OCREDITCARD VISA/MC_
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LEITER 0 YES 0 NO
City of Menifee Building& Safety Deportment 29714 Houn Rd. IvIenifee, CA 92586 951-672-6777
www.citycfmenifee.us Inspection Request Line 951-246-5213