PMT17-03004 City of Menifee Permit No.: PMT17-03004
29714 HAUN RD.
--ACCE!Lh? MENIFEE,CA 92586 Type: Residential Electrical
MENIFEE Date Issued: 08/24/2017
PERMIT
Site Address: 27626 AVENIDA INTERNO, MENIFEE, CA Parcel Number: 333-274-005
92585 Construction Cost: $1,900.00
Existing Use: Proposed Use:
Description of MAIN PANEL UPGRADE 225A
Work:
Owner Contractor
ROBERT SHORES MYERS ELECTRIC CO
27626 AVENIDA INTERNO 425 W LA CADENA DR#21
MENIFEE, CA 92585 RIVERSIDE,CA 92501
Applicant Phone:9516628769
MYERS ELECTRIC CO License Number: 972274
425 W LA CADENA DR#21
RIVERSIDE, CA 92501
Fee Description gty Amount 141
Services, Switchboards, Control Centers&Panels 1 11&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_Peroit_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 o 1 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-'-r c L{L License o. _1 B signature below l acknowledge except
- - F --- - /06 'V;- Y m Y nature g g p y personal residence
Expires /'3 a r 7 t a Signature_ :::� 1r I in which I must have resided for at least one year priorto completion of
WORKER'S COMPENSATION DECLARATIONel improvements covered bythis permit.I cannot legally sell a structure that I
have built as an owner-builder K it has not been constructed in its entirety by
in 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
this permit is issued. www.leeenfo.ca.eov/calaw.html.
Policy 8 Date
OrFhave 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 p 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:
ram )) application and the information I have provided is correct.I agree to comply
RCarrier T 6a �o44-t It., with all applicable city and county ordinances and state laws relating to
y PC building construction.I authorize representatives of this city or county to
Policy g EW(p H(Z O b to z u Expires 4 A-x �1R enter the above identified property for inspection purposes. /(This section need not to be completed is the permit is for one-hundred ` � 5J Date 2r '3 // 7
dollars($lOD)or less PR07fiTY OWNER ORAUTHORIZED AGENT
o 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 g bc`L
6&0 _2—i
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 thoseprovisions. Will the applicant or future building occupant handle hazardous material or a
h_
Applicar �, � 9 s Date i�J�/-7 mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAI E TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes in No
UNLAWFUL,AND SHALL SUBIECTAN 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 District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes 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) o 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 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
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to ciYes o 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 OWN ER OR AUTHORIZED AGENT
that he or she Is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRPI
License Law(Chapter9(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 Rcensure receiving compensation for most work that disturbs paint to apre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving or childcare n forfacili most
be R k that disturbs
firms and comply with
than
Applicant fora permit subjects the applicant too 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
ci 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.vov/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 a o 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. o 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.
Jq,h ZA. ., n
4�5re-.rlr-'
BUILDING & SAFETYPERMIT/PLAN CHECK APPLICATION
4 i'•/iG-'ll :fa e
DATE 8/23/17 PERMIT/PLAN CHECK NU y
TYPE: C COMMERCIAL 'X RESIDENTIAL ) MULTI-FAMILY 0MOBILEHOME c; POOL/SPA ' SIGN
SUBTYPE: CI ADDITION -CD ALTERATION _ DEMOLITION (X ELECTRICAL '� MECHANICAL
{' NEW O PLUMBING c.` RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK ( N ) 225A Main Panel
PROJECTADDRESS 27626 Avenida Interno
ASSESSOR'S PARCEL NUMBER 333- ,?ILA -OCR LOT TRACT
OWNER NAME Robert Shores
ADDRESS 27626 Avenida Interno
PHONE EMAIL
APPLICANT NAME Holly Thompson
ADDRESS 7100 W Florida Ave
PHONE 951-537-6859 EMAIL holly.thompson@horizonsolarpower.com
CONTRACTOR'S NAME OWNER BUILDER? YES NO
BUSINESS NAME Myers Electric
ADDRESS 425 W La Cadena Dr# 21
PHONE 951-662-8769 EMAIL
CONTRACTOR'S STATE LIC NUMBER 97;274 LICENSE CLASSIFICATION C-10
VALUATION$ 1,900.00 /�SO F�T� L SQ FT
APPLICANT'S SIGNATURE � ,n DATE 8/23/17
CITY STAPF USE t
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ' SMIP y—
INVOICE PAID AMOUNT
AMOUNT 1L+01 .'�O ^CASH `CHECK# :'CREMTCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CASH '..:CHECK# :'CREDITCARD VISA/MC
OWNER BUILDER VERIFIED `-.'--YES ' NO DL NUMBER NOTARIZED LETTER YES C? NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213