PMT16-04514 City of Menifee Permit No.: PMT16-04514
29714 HAUN RD. Type: Residential Electrical
<ACCELP;> MENIFEE, CA 92586
fm.m+evF:;Alaxe MENIFEE Date Issued:
12/29/2016
PERMIT
Site Address: 28811 MURRIETA RD, MENIFEE, CA Parcel Number: 339-133-003
92586 Construction Cost: $3,000.00
Existing Use: Proposed Use:
Description of MAIN PANEL UPGRADE 125A
Work:
Owner Contractor
GARY PHILLIPS ENERGY REMODELING INC
28811 MURRIETA ROAD 22120 CLARENDON STREET STE 200
MENIFEE, CA 92586 WOODLAND HILLS, CA 91367
Applicant Phone:8772454672
JASON JONES License Number.968844
ENERGY REMODELING INC
22120 CLARENDON STREET STE 200
WOODLAND HILLS, CA 91367
Fee Description Qtv Amount f5l
Services, Switchboards, Control Centers& Panels 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 carded on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifae.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
1 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 ❑I am exempt from iicensure under the Contractors State License Law for
Professions Cade and my license is in full force and effect. the following reason:
License Class G IU Licens No. /r B m signature below I acknowledge that,except for m
q Y y g g p y personal residence
Expires 2- 3 I '"I / 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 D ON have built as an owner-builder if it has not been constructed in its entirety by
❑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 this permit is issued. www.Ieeinfo.ca.eov/calaw.htmI.
g 1
Policy# -1 C2 �/— 5 (U) - 5 Date
P RTY OWN 'AUTHORIZED AGENT
D I have and will maintain workers compensation insurance,as required by
section 3790 of the Labor Code,for the performance of the work for which ❑By my sig ature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier 5+,,L4-e Co with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# 7O ' S 70 Expires -7 3 j / enter the above identified property for inspection purposes.
(This section need not to be completed is the permit Is for one-hundred [late
dplla ($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
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#
workers compensation laws of California,and agree that if I should became HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall fort)ati comply w, se provisions. n of Will the applicant or future building occupant handle hazardous material or a
Applicant Date I� - - / �6 mixture containing a hazardous material equal to or greaterthat the
amounts specified on the Hazardous Materials Information Guide?
W G:FAILUR SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No
WFUL,A HALLSUBJECT 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
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 ❑Yes ❑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) ❑Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
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 reasons)indicated below by the California Health al Safety Cade,Section 25505 and 25534 concerning
hazardous material reporting.
checkmarklSJ I have placed next to the applicable item(s)(Section 7031.5 oyes ❑No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRPI
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
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
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 or through their
o 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.eoa.aov/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 Contractor's State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be 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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑I,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
en'f22
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL "ESIDENTIAL O MULTI-FAMILY O MOBILE HOME -- POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION 01'LECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES a C'ity of v'e-oe
Rmf
t1 f- uil
DESCRIPTION OF WORK LJ �n IJ1° lu e
PROJECT ADDRESS /vj goeBuReceived
ASSESSOR'S PARCEL NUMBER , 1• 123• (D3 LOT TRACT
OWNERNAME I P5
ADDRESS $ M U r r 4 `� R
PHONE I S - 30 — $t'J 3 S EMAIL
APPLICANT NAME Eta Q f Z Q r U Q'I In jr)(
ADDRESS GG�-� )lL) ^.� 9 F �0 n ,, C 2123
PHONE `� 5D -�22 -�77) EMAIL corn
CONTRACTOR'S NAME ` OWNER BUILDER? O YES (ENO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION )D
VALUATION$ 3 0(20 SO FT L SO FT
APPLICANT'S SIGNATURE - "' DATE
CITY STAFF USE ONLY
DEPARTMENT UISTRIMM CI IY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP I )e
INVOICE Q• PAID AMOUNT 0j.
AMOUNT _1 JLkO CASH OCHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213