PMT17-01915 City of Menifee Permit No.: PMT17-01915
29714 HAUN RD.<A-CCEL/-> M ENIFEE, CA 92586 Type: Residential Electrical
MENIFEE Date Issued: 06/29/2017
PERMIT
Site Address: 25220 RIDGEMOOR RD, MENIFEE, CA Parcel Number: 339-361-027
92586 Construction Cost: $1,800.00
Existing Use: Proposed Use:
Description of MAIN PANEL UPGRADE 200A
Work:
Owner Contractor
ANNETTE&DENNIS GAMBLE D T E
25220 RIDGEMOOR ROAD 5753 EL PALOMINO DRIVE
MENIFEE, CA 92586 RIVERSIDE, CA 92509
Applicant Phone: 9514440379
License Number:978905
Fee Description Oft Amount($
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 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_81dg Pennit_Template.rpt Page 1 of 1
LICENSED DECLARATION CITY OF MENIFEEproperty who builds or improves thereon,and who contracts for the projects
I herebyaffirm under penalty of perjurythat 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 01 am exempt from Iicensure under the Contractor's State License Law for
Professions Code and my license Is in full force and effect.
n,� the following reason:
License Class C—\N'1 y 'cerise N . S� `!Z6
1n^_�., By my signature below lacknowledge that,except for my personal residence
Expires 1\ O Signature ..-. U.r'1 in which I must have resided for at least one year priorto completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
O I hereby affirm under penalty of perjury one of the following declarations:I have built as an owner-builder if it has not been constructed in its entirety by
have and will maintain a certificate of consent of self-Insure following
declarati licensed contractors.I understand that a copy of the applicable law,Section
compensation,issued by the Director of Industrial Relations as provided for 7044 of the Business and Professions Code,is available upon request when
by Section 3700 of the Labor Code,for the performance of work for which this application is submitted or at the following website:
this permit is issued. www.leRinfo ca gow`calaw html.
Policy#
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 0 By 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 owner's behalf.I have read this
numberare: application and the information 1 have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
Pobcy# Ex Tres building construction.I authorize representatives of this city or county to
P enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less Date
41I certify that in the performance of the work for which this permit is issued, PROPERTY OWNER OR AUTHORIZED AGENT
I shall not emolov 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
subject to the worker's compensation provisions of Section 3700 of the Labor HAZARDOUS MATERIAL DECLARATION
Cade,I shal orthwith amply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicants*^ Vv�tf ,(�,t,�� Date mixture containing a hazardous material equal to or greater that the
amounts
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ciYes ci Noifled on the Hazardous Materials Information Guide?
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,ODO),IN Will the Intended use of the building by the applicant or future building
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
CONSTRUCTION LENDING AGENCY for guidelines
ayes ONO
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 o 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
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 items)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to DYes 0 No
construct,alter,improve,demolish or repair any structure,prior to its Date
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPARENOVATION REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt from Iicensure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint in a pre-1978
an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to be RRP-certified firms and comply with
than($500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves orthrough their
❑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.gay/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
property who,through employees'or personal effort,builds or improves the 0 An EPA Lead-Safe Certified Renovator will be responsible for this project
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
completion,the Owner-Builder will have the burden of proving that it was Firm Certification NO.:
not built or improved for the purpose of sale. 0 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