PMT16-04498 City of Menifee Permit No. PMT16-04498
29714 HAUN RD. Type: Residential Electrical
<A-CCIE-LA? MENIFEE, cA925a6
MENIFEE Date Issued: 12/28/2016
P E R M I T
Site Address: 23711 ELSINORE LN, MENIFEE, CA Parcel Number: 35G-191-021
92587 Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of ELECTRICAL PANEL UPGRADE TO 200AMP FOR SOLAR PERMIT PMT16-03884
Work:
Owner Contractor
ROBERTO CAMARILLO RICARDO CASTANEDA
23711 ELSINORE LANE 2795 JUNE PLACE
MENIFEE,CA 92587 SAN BERNARDINO, CA 92407
Applicant Phone:9096594466
ERIK DUARTE License Number: 1000650
2795 JUNE PLACE
SAN BERNARDINO, CA 92407
Fee Description QtV Amount
Receptacle, Switch,OuOet&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 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_Pemt-Ternplate.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 7aoo)of Division 3 of the Business and a I am exempt from licensure under the ContractoesState License Law for
Professlions Code and my license is in full force and eifect. the following reason:
License By my signature below I acknowledge that,except for my personal residence
Expires in which I must have resided for at least one year ptiDr to completion of
improvern ents covered by this permit I cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirely by
a I hereby affirm under pena Ity of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have a nd 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.leginfo.ca.goy/calaw.litmi.
Policy# Date
)KI 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 a By my signature below I certify to each of the folloiving:I a m the property
this perm it is issued.My worker's compensation insurance ca rrier and policy owner or authorized to act on the property owner's behalf.I have read this
number arw. application and the Information I have provided is correct.I agree to Comply
Carrierg—IA-vt (/-Ow with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# IN�?-_Z<_ —Expires 16 410 11 -7 enter the above Identified property for inspection purpmes.
(This section need not to be completed is the permit is far one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
a I certify-that in the performance of the work for which this permit is issued, 0 1543!5
1 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 worker's compensation provisions of Section 3700 of the Labor
Code,I shall fort omply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant ions' ate Y�/, mixture containing a hazardous material equal to or greater that the
t'— amounts specified on the Hazardous Materials Information Guide?
e prov'5
CM S ayes '11NO
WARNING:FAILLIRETO SECURE Wd -�S�COMPENSATICN COVERAGE 15
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($10D,000),IN
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modifintion from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATrORNEYS FEES Coast Air Quality Ma nagement District(SCAQM D)?See perm itting checklist
forguidellnes
CONSTRUCTION LENDING AGENCY a Yes 2(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) ayes A 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 req uIrements 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 item(s)(Section 7032.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to ayes tKNo
Date
construct,alter,improve,demolish or repair any structure,prior to Its NER OR AU?9EIRIZED 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(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)or that he or she is exempt from licensum 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,certified firms and comply with
a n 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 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( )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 Contnictor'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 a re not intended or offered for Certified Firm Name.
sale.If,however,the building or improvement is sold within one year of Firm Cerfirication No.:
completion,the Owner-Builder will have the burden of proirling that it was
not built or Improved for the purpose of sale. a No EPA Lead-Safe Certified Firm is required for this project bemuse:
a 1,as owner of the property am exclusively contracting With licensed
contractors to construct the project(Section 7D44,Business and Professions
Code:The Contmctor'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
"'Men*fee
A
DATE -28 PERMIT/PLAN CHECK NUMBER oppTgo, oqt(IS
TYPE: 0 COMMERCIAL W-R'ESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION OALTERATION ODEMOUTION 01LECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
wo 4,2�
PROJECTADDRESS :23 70 CA 12- 5k,2
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
ADDRESS CA 92 58 7
PHONE EMAIL
APPLICANTNAME C
ADDRESS Z_765 lei(,-a I 5?z"oi
PHONE ?w 6's EMAIL C?M gj�jr a 1�7 kAt-voq� 'dip CAVI colvv,4
CONTRACTOR'S NAME L��A] OWNER BUILDER? 0 YES aAO-�
BUSINESS NAME _&Aoi-",-r,, 94vv�J
ADDRESS 2-7'F5 r4 P/q q (?j
PHONE 5,6)9 4 s 7 (/v 6 6 EMAIL
CONTRACTOR'S STATE LIC NUMBER 10006-50 LICENSE CLASSIFICATION c /D
VALUATION$ SO FT LSQFT
APPLICANIT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTIUN LI IY UV WNIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE � GREEN 3;�,p
INVOICE � PAID AMOUNT
AMOUNT I � --CASH 0 CHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT I 1 0 CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 No DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building& Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
WWW.City0fMenifee.US Inspection Request Line 951-246-6213