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PMT17-02310 City of Menifee Permit No.: PMT17-02310 29714 HAUN RD. <A—CCELA> MENIFEE, CA 92586 Type: Residential Electrical MENIFEE Date Issued: 0 7/0 312 01 7 PERMIT Site Address: 27765 WATSON RD, MENIFEE,CA 92585 Parcel Number: 329-201-008 Construction Cost: $400.00 Existing Use: Proposed Use: Description of CHANGE OUT EXISTING 100 A PANEL-LOCATED OUTSIDE ON THE MOBILEHOME-SAME SIZE, Work: SAME LOCATION Owner Contractor ROBERT FOWLER THOMAS BROOKE PAYNE 27765 WATSON ROAD 1776 PALA LAKE DRIVE MENIFEE,CA 92585 FALLBROOK, CA 92028 Applicant Phone:9514913698 CECE MAY License Number:637432 THOMAS BROOKE PAYNE 1776 PALA LAKE DRIVE FALLBROOK, CA 92028 Fee Description Qtv Amount 1E1 Services, Switchboards, Control Centers&Panels 1 116.00 Building Permit Issuance1 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 requidng 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_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 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 Contractor's State License Law for Professions Code and my license is in full force and effect. the following reason: License Class 'O License No. j By my signature below I acknowledge that,except for my personal residence Expires y 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 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 syww.leeinfo.ca.esv/calaw.html. this permit is issued. 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 ❑By my signature below 1 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 a,rea�: / application and the information I have provided is correct.I agree to comply Carrier �`1.�z4 2.XG /�P� with all applicable city and county ordinances and state laws relating to ./ building construction.I authorize representatives of this city or countyto Policy# G/ �� Expires-7/- /S,f 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 ❑I certify that in the performance of the work for which this permit is issued, I shall not emslov 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 comply with those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant Date mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WOR ER'S COMPENSATION COVERAGE IS ❑Yes A No 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 occupant require a permit for the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR INSECFION3706:OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist -for guidelines - _-_-- --- - CONSTRUCTION LENDING AGENCY ❑Yes 7a'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 Flo 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 requirements underthe 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. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 des ❑No Y n Business and Professions Code).Any city repair that requires a permit to Date 21 � issuconance,also alter,improve, applicantsh for pairany mittofile a signets its PROPERTY OWNER OR A—UFTE RIZED AGENT issuance,also requires the applicant for the permit is file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRP) 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 paint contractors receiving compensation for most work that disturbs paint in apre-1978 and the basis for the alleged exemption.Anyviolation 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($500). managers who clothe paint-disturbing work themselves or through their ❑1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit: compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.zov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323). Code;The Contractor's State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project property who,through employees'or personal effort,builds or improves the property provided that the improvements are not intended or offered for Certified Firm Name: sale.If,however,the building or improvement is sold within one year of Firm Certification No.: completion,the Owner-Builder will have the burden of proving that It was not built or improved for the purpose of sale. City Of Menitee 6 t ❑No EPA Lead-Safe Certified Firm is required for this project because: ��{{��paa & Safety D P q J o I,as owner of the property am exclusively contracting'14n Nansed contractors to construct the project(Section 7044,Business gr{�rofR lrg017 Code:The Contractor's State License Law does not apply to e a L 1 If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement. Received BUILDING i SAFETY PERMIT/PLAN CHECK APPLICATIONYE -,*,Aenifee DATE 0 D J �O�� PERMIT/PLAN CHECK NUMBER p1�1T ' b231 TYPE: :% COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA : SIGN SUBTYPE: O ADDITION "ALTERATION •O DEMOLITION &ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES- DESCRIPTION 7I Y OF WORK � O A v1 `z l r PROJECT ADDRESS 0 ASSESSOR'S PARCEL NUMBER 3a49 at)) •'Dj)8 LOT TRACT OWNER NAME 1" ADDRESS PHONE 9.51- . , -57* EMAIL r D APPLICANT NAME p 'F ADDRESS a77 O PHONE !a5_1.-9:r42-$'J//IG EMAIL CONTRACTOR'S NAME OWNER BUILDER? O YES •NO BUSINESS NAME ADDRESS 1 77 y)A PHONE EMAIL pay P CrP_A'P,.R? CONTRACTOR'S STATE NLIC�NUMBER (o37y. LICENSE CLASSIFICATION VALUATION $ 4W• SO FT L SO FT APPLICANT'S SIGNATURE DATE 0I DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSIN SS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN I' SMIP )LioD V INVOICE �GI •� PAIDAMOUNT `� ,� AMOUNT ` I CASH O CHECK G CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Buil &WgA�A&partment 29714 Haun Rd. Menifee, CA 92586 951-672-67z BuAdimg 18ySA"ijQ9Rk Inspection Request Line 951-246-6213 JUL 0 3 2017 Received G��✓