PMT17-01503 City of Menifee Permit No.: PMT17-01503
_ 29714 HAUN RD. Type: Residential Electrical
<A-CCELA- MENIFEE,CA 92586
MENIFEE Date Issued: 0511512017
PERMIT
Site Address: 28710 E WORCESTER RD, MENIFEE, CA Parcel Number: 337-123-007
92586 Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of ELECTRICAL PANEL UPGRADE FROM 100AMP TO 125AMP
Work:
Owner Contractor
CASSIE SINGLETON T AND M SOLAR INC
28710 E WORCESTER RD 6339 NANCY RIDGE DR STE 100
MENIFEE,CA 92586 SAN DIEGO, CA 92121
Applicant Phone:8585649707
ARMANDO CARRERA License Number:927576
T AND M SOLAR INC
6339 NANCY RIDGE DR STE 100
SAN DIEGO, CA 92121
Fee Description Oft Amount f51
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 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_Pennit_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 ❑I am exempt from licensure under the Contractors State License taw for
Professions Code and my license is in full force and effect. the following reason:
License Class ` License N C!Z S� By my signature below 1 acknowledge that,except for my personal residence
Expires O / 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
o 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 workers 70"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 websile:
by Section 3700 of the Labor Code,for the performance of work for which www.leginfo.ca.goy/calaw.litmi.permit is issued.
Policy# Date
,xQhave and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which 3e r(!my signature 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 hehalf.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
policy#3 Z.�j/� Expires 7 3 19" enter the abo 'dentified prope for inspection purposes.
(This section need not to he completed is the permit is for one-hundred
Date
dollars($300)or less r
PROPERTY OWNER O AUTHORIZED AGENT
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 become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwit ply with those visions. C Will the applicant orfuture building occupant handle hazardous material or a
Applicant �yGt rya. Date �j ZO�;L_ mixture containing a hazardous material equal to orgreater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes tiLN0
UNLAWFUL,AND SHALL SUBIECFAN 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 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 hecons(SCtionor modee ification
South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES ecklist
for guidelines
CONSTRUCTION LENDING AGENCY aYes 2<90
1 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 lino ary of a school?
(Section 3097 Civil Code) o Yes No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that 1 am exempt from the permitting checklist.I understand my requirements under the State of
California Health
Contractors License Law for the reason(s)indicated below by the 8:Safety Cade,Section 25505 and 25534 concerning
hazardous m
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ma porting.
Business and Professions Code).Any city or county that requires a permit to oyes e� ,
construct,alter,improve,demolish or repair any structure,priorto its Date
PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant forthe permit to file a signedstatement
that he or she is licensed pursuant to the provisions of the Contractors 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 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 I,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 Contractors State License Law does not apply to an owner of o 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 forthis 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 Contractors 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
.doY'_'
:` 'F Menifee
DATE 5'/ ZEl� PERMIT/PLAN CHECK NUMBERT"T11150
TYPE: O COMMERCIAL AIESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION k-fLECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK G lUU U
/li Lvi lOU
PROJECTADDRESS O �-oY
ASSESSOR'S PARCEL NUMBER 337/Z34V 4 LOT /Z-9 TRACT
OWNER NAME
ADDRESS ;�-l0 �'• Gt/
PHONE _rj f/. 014- EMAIL
APPLICANT NAME
ADDRESS
PHONE �LF . Ysf• S3CI J EMAIL
CONTRACTOR'S NAME 7 i/ /LIO/c�� OWNER BUILDER? O YESANC
BUSINESS NAME 7- 4&fal A-1 -561
ADDRESS �a l� l�ilVfy7Gvt �✓f. 7`A�i'fL �t ��iv/ /// p / �� z
7 PHONE d • S2Z'_ S�ZSc _ EMAIL -f avt� q��fU�4✓. GOw�_
CONTRACTOR'S STATE LIC NUMBER �� 7�',s�-j LICENSE CLASSIFICATION /Q
VALUATION$ OO Q FT L SQ FT
APPLICANT'S SIGNATURE DATE /7Z
i
r
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN $MIP l.i.
INVOICE PAID AMOUNT
AMOUNT I I OCASH OCHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# 0CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES 0 NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Department 29714 Noun Rd. Menifee, CA 92586 951-672-6777
www.citvofinemfee.us Inspection Request Line 951-246-6213