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PMT17-03191 City of Menifee Permit No.: PMT17-03191 29714 HAUN RD." Type: Residential Electrical �CCELAl7. MENIFEE CA 92586 " ... MENIFEE Date Issued: 09/11I2017 PERMIT Site Address: 28722 MURRTEA RD, MENIFEE, CA Parcel Number: 337-121-008 92586 Construction Cost: $2,000.00 Existing Use: Proposed Use: Description of REMOVE AND REPLACE PANEL-SAME SIZE(100A)AND SAME LOCATION Work: Owner Contractor JOHN TOBINSKI ROBERT COONEY ELECTRIC SERVICES 28722 MURRIETA RD 39625 KILKARE CIRCLE MENIFEE, CA 92586 MURRIETA„CA 92562 Applicant Phone:9513481661 ROBERT COONEY License Number: 766326 ROBERT COONEY ELECTRIC SERVICES 39625 KILKARE CIRCLE MURRIETA, CA 92562 Fee Description gyt Amount($I 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_Permit_Template.rpl Page 1 of 1 CITY OF MENIFEE (Expires CENSED DECLARATION property who builds or improves thereon,and who contracts forthe projects hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law). hapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from Iicensure under the Contractor's State License Law for rofessions Code and my license is in full force and effect. the following reason: cense Class -1 O License No. o� J Z�J By my signature below I acknowledge that,except for my personal residence 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 ORKER'S COMPENSATION DEC TION have built as an owner-builder if it has not been constructed in its entirety by , f'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 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, Q(ty0 vMww.lppinfo.ca.gov/calaw.html. this permit is issued. �U/1O/Ih�$ S�'/1/�e0� Policy# `3l Date ❑I have and will maintain workers compensation insurance,as required by f ' PROPER OWNER OR AUTHORIZED AGENT section 3700 of the Labor Cade,for the performance of the work for which 4-my signature below I certify to each of the following:I am the property this permit is issued.My worker's compensation insurance carrier an(�[[li11cy owner or authorized to act on the property owners behalf.I have read this numberare: eCe0 application and the information I have provided is correct.I agree to comply 1. Carrier V all applicable city and county ordinances and state laws relating to -bhlldi ng construction.I authorize representatives of this city or county to Policy# 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 P OPERTY OWNER OR AUTHORIZED AGENT ❑I certify that in the performance of the work for which this permit is issued, I shall not emol0y 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 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 ram' Dale 7 // "7 mixture containing a hazardous material equal to or greater thatthe amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ,p Yes ❑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 Coast AIr Quality Management District(SCAQMD)?See permitting checklist IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines ONSTRUCTION LENDING AGENCY q.Yes ❑No hereby affirm that under the penalty of perjury there is a construction Will the proposed building or no facility be within 1000 feet of the lending agency for the performance of the work which this permit is issued outer be, of a school? (Section 3097 Civil Code) .❑Yes ❑No OWNER BUILDER.DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD hereby affirm under penalty of perjury that am exempt from the permitting checklist.I understand my requirements under the State of Contractors License Law for the reason(s)indicated below by the California Health al Safety Code,Section 25505 and 25534 concerning hazardous material reporting. checkmark(s)I have placed next to the applicable items)(Section 7031.5 es o No Business and Professions Code).Any city or county that requires a permit to Date construct,alter,improve,demolish or repair any structure,prior to its opt R WNER OR AUTHORIZED AGENT issuance,also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIRAND 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)orthat he or she is exempt from Iicensure receiving compensation for most work that disturbs paint in a pre-1978 and the basis forthe 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 ❑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,tQgovllead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(S323). 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 for the purpose of sale. ❑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 70",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. & SAFETY PERMIT/PLAN CHECK APPLICATION Menifee DATE:(f1 1 I PERMIT/PLAN CHECK NUMBERFWJ I-U l01 TYPE: 0 COMMERCIAL RESIDENTIAL OMULTl-FAMILY 3 MOBILE HOME Ci POOL/SPA O.SIGN SUBTYPE: 0 ADDITION C ALTERATION 0 DEMOLITION ELECTRICAL 0 MECHANICAL O NEW O PLUMBING 0 RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK 0 PROJECTADDRESS Z� ' Z ,�S`�� ye�Q�--;n Cl ZIP ZSj ASSESSOR'S PARCEL NUMBER 331•�2.1 •W p LOT 2- TRACT OWNER NAME ADDRESS ZZ -C�Qq 1 PHONE -MT bR 6-7 EMAIL APPLICANT NAME ADDRESS PHONE(s:r� l !F�LjQ,- \CO�o , EMAIL qc^� a Cf' lCG/(�.(1e CONTRACTOR'S NAME OWNER BUILDER? OYES 2/NO BUSINESS NAME r�- GCODenC, ADDRESS ,6 C �T PHONE IU ( ��Ejt EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION C.-f O VALUATION$ SQ FT L SQ FT APPLICANT'S SIGNATURE DATE 4 7 CITY STAFF USE ONLV DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE IyUMBER BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY: V/OL-frp on 1 in PERMIT FEE 1UF1 ,�. SMIP GREEN PLAN CHECK FEE I INVOICE TOTAL OWNER BUILDER VERIFIED 'O YES 0 NO DRIVERS LICENSE If NOTARIZED LETTER O YES 0 NO City-of Menifee Building & Safety Dept. SEP 0 8 201 Received