PMT17-02850 City of Menifee Permit No.: PMT17-02850
29714 HAUN RD.
r�CCEL/� MENIFEE, CA 92586 Type: Residential Electrical
MENIFEE Date Issued: 08/11/2017
PERMIT
Site Address: 24400 CONEJO DR, MENIFEE, CA 92587 Parcel Number: 341-180-049
Construction Cost: $500.00
Existing Use: Proposed Use:
Description of UPGRADING 200 AMP TO A 225 AMP ON PANEL ON POLE.
Work:
Owner Contractor
KATTY BROWN NICHOLAS ROMERO
24400 CONEJO DR P O BOX 1495
WILDOMAR, CA 92595
Applicant Phone: 9512172000
NICHOLAS ROMERO License Number: 768673
NICHOLAS ROMERO
P 0 BOX 1495
WILDOMAR, CA 92595
Fee Description city Amount tEl
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 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_Pernit_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 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 ❑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 io License No.7k2 �� By my signature below I acknowledge that,except for my personal residence
Expires BG 3D 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 www.Iegmfo.ca.gov/caIaw.htnnI.permit is issued.
Policy p 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 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.Iagree 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 A 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
❑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 q
workers c=HUNDRED
n laws of California,and agree that if I should become (HAZARDOUS MATERIAL DECLARATION
subject to 's compensation provisions of Section 3700 of the Labor
Code,I shply with those provisions. //__ Will the applicant or future building occupant handle hazardous material or a
ApplicantDate uV mixture containing a hazardous material equal to or greater that the
mounts specified on the Hazardous Materials Information Guide?
WARNING SE RE WORKER'S COMPENSATION COVERAGE IS ❑Yes !j No
UNLAWFL SU ECFAN EMPLOYER TO CRIMINAL PENALTIESWill the intended use of the building by the applicant or future building
AND CIVIO ONE HUNDRED THOUSAND DOLLARS($500,000),INccupant require a permit for the construction or modification from South
ADDITION 70 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FORoast Air Quality Management District(SCAQMD)7 See permitting checklist
IN SECTION 371160E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES or 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 issueduter boundary of a school?
(Section 3097 Civil Code) Yes JNo
OWNER BUILDER DECLARATIONS have relad the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury[hat am exempt from the ermitting checklist.I understand my requirements under the State of
Contractors License Law for the reasons)Indicated below by the alifornia Health&Safety Code,Section 25505 and 25534 concerning
azardous material reporting.
checkmark(s)I have placed next to the applicable items)(Section 7031.5 (sa No Businessand Professions Code).Any city or countythat requires a permit to r a� Date
construct,alter,improve,demolish or repair any structure,prior to its ROPERTY OWNER AUTHORcIYED AGENT
issuance,also requires the applicant forthe permit to file a signed statement \\\\\\
that he or she Is licensed pursuant to the provisions of the Contractors State EPA RENOVATION.REPAIR AND PAINTING IN
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 licensure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
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 workthemselves or through their
❑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.e�,a_gov lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80G-424-LEAD(5323).
Code;The Contractors 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 forthe purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑1,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.
: APPLICATION
DATE PERMIT/PLAN CHECK NUMBER �l ryir V1 - 02b5U
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION C ELECTRICAL C; MECHANICAL
{% NEW O PLUMBING ' RE-ROOF-NUMBER OF SQUARES
2 5
DESCRIPTION OF WORK J9 �\J o tNI.' "vL In I 94C r
now UX6+4 Pxwl, Ono Poles. c� � I
PROJECTADDRESS .14400 CONE��,b^^ �� C�ft�L! � VfiIIEy CIA _`�Sp
1
ASSESSOR'S PARCEL NUMBER ?)Aft —Iyv - 0'4q LOT Z-+ TRACT
OWNERNAME I'` rJ{01N'N
ADDRESS Z`" 00 Coo i D Of. crua1l Z6p
PHONE QQq 41461 EMAIL -----
APPLICANT NAME bLRS Rc_>
ADDRESS F0 +x'F 14G 0_4 g25g5
PHONE ctst Z I-7-2690 EMAIL - -rA g Nk7
CONTRACTOR'S NAME Njd 4es S gomeee OWNER BUILDER? 0 YES ` NO
BUSINESS NAME STIA L.l �VT ',1 p
ADDRESS ate. �X I-{ .> �fJ11LQM - 0A Z� 15
PHONE q6l-2/7--26W EMAIL �' r'I, �'? E IC q CC'Vn
CONTRACTOR'S STATE LIC NUMBER 76&73 LICENSE CLASSIFICATION Cl IO
VALUATION $ SSW . SO FT L SO FT -7
APPLICANT'S SIGNATURE DATE "U-l� �� 1
�ITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOICE Q PAID AMOUNT
AMOUNT �T�• 0 CASH CHECK 0 O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT C CASH 0 CHECK# O CREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZEDLETTER O YES C' NO
City Of Menifee 3uildinq&9Gfe y Dea. L ?, td7 i9 HDun Rd. Nleni ._=, : . 9%58S 951-572-677?
www.cityofinenifee.:!s;nspecrian isequest Line95_-2r;6-05Gl-