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PMT17-00201 City of Menifee Permit No.: PMT17-00201 29714 HALIN RD. Type: Residential Electrical <ACCEL/? MENIFEE,CA 92586 `"'""'"A Wt. ° MENIFEE Date Issued: 01/25/2017 PERMIT Site Address: 29831 CARMEL RD, MENIFEE, CA 92586 Parcel Number: 336-122-005 Construction Cost: $1,530.00 Existing Use: Proposed Use: Description of ELECTRICAL SERVICE CHANGE DAMAGED 100AMP Work: Owner Contractor LUPE FABROS GARRETT ELECTRIC 29831 CARMEL RD 12980 ARVILA DRIVE MENIFEE,CA 92586 VICTORVILLE, CA 92392 Applicant Phone:7607928447 CLIFF GARRETT License Number.786652 GARRETT ELECTRIC 12980 ARVILA DRIVE VICTORVILLE, CA 92392 Fee Description O_yt Amount(El 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 building operations being carded on thereunder when in violation of the Building Code or of any other ordinance of City of Menifee.Except as otherwise stated,a peril 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 I hereby affirm under penalty of perjury that 1 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 licensure under the Contractor's State License Law for Professions Code and my license Is in full force and effect. the following reason: License Class Q—1 License No. ?zF By my signature below I acknowledge that,except for my personal residence Expires �G`I`�J �/�zQSignature C� � in which I must have resided for at least one year prior to completion of improvements covered by this permit.)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 ❑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.leeinfo.ca.Rpv/calaw.htm 1. this permit is issue/ Polity It Date ❑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 ❑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 19 certify that in the performance of the work for which this permit is issued, I s all 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 compl with those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant Date / � ! mixture containinga hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILUR 70 SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes 1flo 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($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the Construction modification from South IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAOMD)D)?See permitting checklist for guidelines CONSTRUCTION LENDING AGENCY ❑Yes 0 610 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 VQo OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAOMD 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 hazardous material reporting. checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 d[es ❑No .may Business and Professions Code).Any city or county that requires a permit to /_�O�i�"�% Date � construct,alter,improve,demolish or repair any structure,prior to Its PROPE WNER OR AUTHORIZED AGENT issuance,also requires the applicant forthe permitto file a signed statement that he or she is licensed pursuantto 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)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-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 ❑1,as owner of the property,or my employee with wages as theirsole 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 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. o No EPA Lead-Safe Certified Firm is required for this project because: o 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. PERMIT/PLANBUILDING & SAFETY APPLICATION Menifee DATE 2 — /7 PERMIT/PLAN CHECK NUMBER I TYPE: O COMMERCIAL W RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION 4PELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK r 15 2rvice cikz /OD /s PROJECTADDRESS 31 Cq��,,//�� --m p a►I., � y, ASSESSOR'S PARCEL NUMBER 3-./(Q �)adlO�7 LOT /"J�O TRACT OWNER NAME /,/ I ADDRESS PHONE G76/— �2 'Ij EMAIL / APPLICANT NAME C/i I!5;c?4-i rr Tr ADDRESS /ryt rj fj0 vi Iry E. e vi Ile 3 9 2 PHONE EMAILCONTRACTOR'S NAME K,-.ram' OWNER BUILDER? O YES #)"NO BUSINESS NAMEya/ ADDRESS PHONE 7L Yam' 79,2—Ae'/y*7 EMAIL i 4 coA CONTRACTOR'S STATE LIC NUMBER 7,��j�� LICENSE CLASSIFICATION l d VALUATION$ e SO FT L SQ FT APPLICANT S SIG ATURE DATE CITY STAFF USE ONLY j DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN ' SMIP INVOICE PAID AMOUNT AMOUNT OCASH CJ CHECKN OCREDfT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT OCASH OCHECKB 0CREDIT CARD 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