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PMT17-03772 City of Menifee Permit No.: PMT17-03772 29714 HAUN RD. Type: Residential Electrical �ACCEL/> MENIFEE,CA 92586 MENIFEE Date Issued: 10/20/2017 PERMIT Site Address: 26840 SOUTHBROOK CT, MENIFEE,CA Parcel Number: 360-512-009 92584 Construction Cost: $1,500.00 Existing Use: Proposed Use: Description of MAIN PANEL UPGRADE 200A Work: Owner Contractor NATHAN HARRIS PARAGONSUN 26840 SOUTHBROOK COURT 126 NEWALL MENIFEE, CA 92584 IRVINE, CA 92618 Applicant Phone:8583860463 CORI LARSEN License Number: 1025115 PARAGONSUN 126 NEWALL IRVINE, CA 92618 Fee Description Oft Amount($ 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_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 with a licensed contractor(s)pursuant to the Contractors State License Law). I hereby affirm under penalty of perjury that I am under provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractors State License Law for Professions Code aa/n'^dd my license is in full force and effe y(i the following reason: License Class Li I U Licen No. O� r� �{�'` By my signature below I acknowledge that,except for my personal residence Expireso 'G ignature l_� in which l 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 Iwfhereby 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 www.leeinfo.ca.¢ov/calaw.html. this permit is issue�d7 /� (1 /� Polity q. 9 —0 "(-7 (P V Date ❑I have and will maintain workers 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:)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 incorrect.I agree to comply Cartier ( C L with all applicable city and county ordinances and state laws relating to (, building construction.I authorize representatives of this cityorcountyto Policy tl Z Expires 09 Z— [d 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 (PRERTY OWNER OR AUTHORIZED AGENT❑I certify that in the performance of the work for which this permit is issued, I shall not emolov any persons in any manner so as to became subject to the USINESS LICENSE 0 workers compensation laws of California,and agree that if I should become RDOUS MATERIAL DECLARATION subject to the workers 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^so,e.c�ified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes 4 UNLAWFUL,AND SHALL SUBJECTAN 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($100,000),IN occupant require a permit for the construction or modification from South ADDITIONIONS 06 OF LABOR CODEi INTEREST, DAMAGESDATTOR ATTORVIDEDNEYS TOR Coast Air Quality Management Dis[rict(SCAQMD)?See permitting checklist -INSECTIOM37060F THE LABOR-CODE,iNTEREST,AND ATTORNEYS FEE$ forguidelines CONSTRUCTION LENDING AGENCY ❑Yes ;40 1 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) Wes ❑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 Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25 Sand 25534 concerning hazardous mater I reporVAA00A checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 �Tes ❑No Business and Professions Code).Any city or county that requires a permit to Date construct,after,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR PATHORIZED 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,REPAIR AND PAINTING IRRPI 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)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in apre-1978 and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare n for most be RRP-certified firms and comply 978 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 ❑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.Rciv/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 ❑An EPA Lead-Safe Certified Renovator will be responsible forthis 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: ❑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 RAP rule please fill out the RRP Acknowledgement ]DL Electric Csib# 918078 1171 Kinbrae Ave. Hacienda Heights CA 91745 To Whom It May Concern, Please allow this letter to serve as authorization for the following individuals to serve on our behalf, as a duty authorized agent for above mentioned company. And as such, the following Individuals may obtain building/trade permits and obtain business licenses on our behalf. Please contact this office if you have any questions or comments. ✓ Jennifer Cole ✓ Randy Cole ✓ Doug Randall ✓ Jane Recktenwald ✓ Rylinde Cole ✓ Judy Hallock ✓ Erik Pasillas ✓ Mike Mills ✓ Cori Larsen ✓ Nick Mobley ✓ Rian Foley Sincerely, Juan De Lara JDL Electric C-10 Csib # 918078 1171 Kinbrae Ave. Hacienda Heights CA 91745 Sew Scanned by CamScanner CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CML CODE§1189 A notary public or other officer completing this certificate verifies only the Identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of Califom ) County offav x )On 04- A .,vf:;? before me, A4-tht. �Z, P/o'('Nry loula l e- Date Here Insert Name and rifle of the Officer personally appeared J y� e L . 4-c Names)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same In his/her/their authorized capacity0es),and that by his/herAheir signature(s)on the instrument the person(s), or the entity upon behalf of which the person(s)acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. NATHAN LOPEZ Commission#2126413 E �/) �//,�,Notary Public•Califomla Signature_ ( %'� 7 Orange County My Comm.Expires Se 28.2019 Signature Of Nota Pub r Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: l{ cr Document Date: Number of Pages: Z Signer(s) Other Than Named Above: X Capecity(es) Cla_!Aed by Signers) Signer's Name: --) .ran lie l wCF Signer's Name: 7r-, ❑Corporate Officer — Title(s): e ❑Corporate Officer — Title(s): X ❑ Partner — ❑ Limited ❑General ❑ Partner — ❑Limited ❑General eral ❑ Individual ❑Attomey in Fact ❑Individual ❑Attomey in Fact ❑Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator ❑Other: x ❑ Other: X� Signer Is Representing: Signer Is Representing: x 02014 National Notary Association-www.Nationa[Notary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907 Scanned by CamScanner