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PMT18-02532 City of Menifee Permit No.: PMT18-02532 29714 HAUN RD. <r CCEL/-> MENIFEE,CA 92586 Type: Residential Electrical MENIFEE Date Issued: 05/24/2018 PERMIT Site Address: 25570 MOUNTAIN PARK DR,MENIFEE, Parcel Number: 358-100-026 CA 92584 Construction Cost: $1,600.00 Existing Use: Proposed Use: Description of MAIN PANEL UPGRADE 225A Work: Owner Contractor MARCOS ORTEGA MYERS ELECTRIC CO 25570 MOUNTAIN PARK DRIVE 425 W LA CADENA DR UNIT 21 MENIFEE,CA 92584 RIVERSIDE, CA 92501 Applicant Phone:9512132108 ASHLEY ATWATER License Number:972274 MYERS ELECTRIC CO 425 W LA CADENA DR UNIT 21 RIVERSIDE,CA 92501 Fee Description QQt r Amount f$1 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 cared on thereunder when In violation of the Building Code or of any other ordinance of City of Menifee.Except as otherwise staled,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 Contractors State License Law for Professions Code and my license is in full force and effect.�J the following reason: License Class L 1�V License' No'.. Ct ,r_�7"—'�L� By my signature below I acknowledge that,except formy personal residence '_Expires i/JL y(/9 Signature 9 A in which I must have resided for at least one year priorto completion of improvements covered by this permit.I Cannot legallysell a structure that I WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by • o 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.leRinfo.ca.gov/caIaw_htmI.permit is issued. ,n, Policy# Date o 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: 1 1^ application and the information I have provided is correct.I agree to comply Carrier g"r S T c- ���Ul with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy# 4 r ss5 3 y Expires 15 I;L- 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 o I certify that in the performance of the work for which this permit is issued, 1 shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE If worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 3700 of the Labor Code,1 shall forthwith comply with those provisions. _ Will the applicant or future building occupant handle hazardous material or a Applicant �� Date S (;uyYA mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑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 Alt Quality Management District(SC construction of See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Airlines Qua CONSTRUCTION LENDING AGENCY o 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 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 Contractors License Law for the reason(s)indicated below by the California Health al Safety ode,Section 25505 and 25534 concerning hazardous material reporting. checkmark(s)I have placed next to the applicable Rem(s)(Section 7031.5 oyes 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 PROPERTY OWN ER OR AUTHORIZED AG ENT 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(RRPJ 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-3978 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 than 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 o 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 I )all of or( )portion of the work,and the structure is www.epa.gov/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 0 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: O I,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. Y '' Menifee DATE: 5- a q PERMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL •RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA I of Menif SUBTYPE: O ADDITION O ALTERATION O DEMOLITION • ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES MAY DESCRIPTION OF WORK an I G r(Z� +c- a.a � yH rq- eceiv o{ PROJECT ADDRESS 256"}D M&L n+A;r7 nG irk n Y ZIP 01 'a s b- `-t ASSESSOR'S PARCEL NUMBER �Ob - L LOT TRACT OWNERNAME IMCtr60S 0r4[ a ADDRESS 'a!5570 o✓nkrnin p4,-k Dr 6.4 7'Asb�( PHONE a0\V -1 a'"S�'� EMAIL APPLICANT NAME A5 /I)tl ,,A-4 c i ovk— ADDRESS L��'y L✓ 14 G44zaol 'Dr NV4e151aC- (f4 cia-.70l PHONE M EMAIL m giSGlti r" o 01 U0 • 0l' r CONTRACTOR'S NAME �T 7 G5 - /'• (�i 5 OWNER BUILDER? OYES ONO BUSINESS NAME /'Aye,,3 Cc.�'yr L ADDRESS 5' w LA c ,+ r;A RIVf!y - G� Ra'�G PHONE 615 2 EMAIL rr+ QiSCIeo.{-nG o �;hGv • ��h CONTRACTOR'S STATE LIC NUMBER a 'a,a�L'� LICENSE CLASSIFICATION VALUATION$ [(,00 SOFT L SQ FT /l APPLICANT'S SIGNATURE DATE 5- l�7 S CI7YSTAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER ACCEPTED BY: BUILDING PLANNING ENGINEERING FIRE PERMITFEE I SMIP GREEN PLAN CHECK FEE INVOICETOTAL OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofmenifee.us 'ys Myers Electric Co. 425 W La Cadena Dr Suite 21 Riverside Ca, 92501 License# 972274 City of Menifee Building Dept. May 14, 2018—May 14, 2019 MAY 2 4 2018 To Whom It May Concern, Received Myers Electric Company, hereby authorizes the following employees to submit and receive permits on our company's behalf: Andrew Stauffacher Joshua Clabaugh Jim Mumme Richard Gutierrez Eric Reading Justin Monjarez Carlos Guerra Clifton Thomas Christian Monjarez Christian Thomas Christopher Senn Chaz Ulloa David Gutierrez Paul Cortez John P Henry Jose Pasillas Benjamin Alejandre Marlene Barroso Kyle Simkiss Michael Guerrero Dominique Annett Anthony Huitron Mike Martinez Ashley Marie Atwater Cordially, Forrest Myers, Owner "Please See attached Myers Electric Co. (951)662-8769 For CA Civil Code Section 1189 Compliant Acknowledgment" MYERS ELECTRIC CO. LICENSE#972274 425 W LA CADENADR SUITE 21 RIVERSIDE,CA 92501 (951)213-2108 MYERSELECTRICCO@YAHOO.COM ALL_ PURPOSE CERTIFICATE OF ACKNOINLEDGMENT 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 California County of�� /d zdfi 0 } On ly�f a3, a0IV before me, Olga R. Cannad , Notary Public ti T g-' / X e nsert name ana a o e or firer personally appeared ! C),�?Aex, r0Grtt,' who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) Is re subscribed to the within instrument and acknowledged to me that <EE�Ehelthey executed the same in Is er/their authorized capacity(ies), and that by Is ier/their 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. OLGA R.CANNADY WITNESS my hand and official seal. Commission#2120582� i T =', Notary Public-California Z p Riverside County H My Comm.Expires Aug 20,2019+ � Notary Publi t n (Notary Public Seal) 6 ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM d This farm complies wrtk current California slarmes regarding notary wording and, DESCRIPTION OF THE ATTACHED DOCUMEE�NT� ifneeded shouldbe compleledandaltachedto the document.Acknohvedgmnsfrom ���(%! F-(G C�J worerdodos incys no becompletedfar documents nanny to sent to that state so long osthe warding does not require the Californiaonria�o�myla violate Cdifmuio notary lmv. ride or escnptlon of attached document) • State and County information must be the State and County where the document signers)personally appeared before the notary public for acknowledgment. (Ttle or description of attached document continued) • Date of notarimtion must be the date that the signer(s)personally appeared which must also be the same date the acknowledgment is completed. e The notary public must print his or her name as it appears within his or her Number of Pages Document Date commission follmod by a comma and then your title(notary public). 4 • Print the name(s) of document signer(s) who personally appear at the time or notarization. ¢ CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plum)forms by crossing of incorrect forms(i.e. he/she/dre);is/are)or circling thecomet forms.Failure tocorecty indicate this a ❑ Individual(s) information may lead to rejection of document recording. ❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines.If seal impression smudges,ne-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. ❑ Partner(s) • Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attorney-in-Fact ❖ Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. Other t• Indicate tide or typo of attached document,number of pages and date. ❑ : Indicate the capacity claimed by the signer.If the claimed capacity is a ,y g corporate officer,indicate the title(i.e.CEO,CFO,Secretary). @9 I@ 2015 Version w%ww.NotaryClasses.com 800-873-9865 Securely attach this document to the signed document with a staple.