PMT18-03267 City of Menifee Permit No.: PMT18-03267
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Electrical
MENIFEE MENIFEE Date Issued: 0 612 812 01 8
PERMIT
Site Address: 30431 TEAL BROOK DR, MENIFEE, CA Parcel Number: 364-154-013
92584 Construction Cost: $400.00
Existing Use: Proposed Use:
Description of MAIN PANEL UPGRADE 225 BUS WITH 200 AMP
Work:
Owner Contractor
ERMA HOUGHTELIN FREEDOM FOREVER LLC
30431 TEAL BROOK DRIVE 43445 BUSINESS PARK DR STE 110
MENIFEE, CA 92584 TEMECULA, CA 92590
Applicant Phone: 8885576431
FREEDOM FOREVER LLC License Number. 1029644
43445 BUSINESS PARK DR STE 110
TEMECULA,CA 92590
Phone: 8885576431
Fee Description ON Amount I51
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 Pepn'd_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 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 o lice se D By my signature below I acknowledge that,except for my personal residence
Expires 3 1 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
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
this permit is ued. wWW.leeinfo.ca.eov/calaw.html.
Policy p 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 o 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: application and the information I have provided is correct.I agree to comply
0- j} G /�Sw�fh/T t f with all applicable city and county ordinances and state laws relating to
Carrier _ _ building construction.I authorize representatives of this city or county to
Polity //��N�Yl� �� 7 9 1 Expires( ( I l q 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 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 worker's c mpensation provisions of Section 3700 of the Labor /
Code,I shall farthx ith Iy t se provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date to /j_B!I mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
RESECU WARNING:FAI RE WORKER'S COMPENSATION COVERAGE IS o Yes trI40
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($300,000),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 guideli s
CONSTRUCTION LENDING AGENCY ❑Yes DNo
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 3G97 Civil Code) o yes G-W
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that i am exempt from the
California Health Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason hazardous materia re s)indicated below by the a ing
checkmark(s)I have glared next to the applicable item(s)(Section 7031.5 ids o Na
Business and Professions Code).Any city or county that requires a permit to Date & �� G
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWN R IITHORIZED 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRPI
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 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($SDO). managers who do the paint-disturbing work themselves or through their
a 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.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 Contractor's 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:
o I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Cade: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
14011, 44C)yack Acknowledgement.
T— P_VR v
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION ®' MENIFEE
Airk �J = u:4, ._.
DATE: 6 7 / PERMIT/PLAN CHECK NUMBER
GRADING/ PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: O COMMERCIAL `RESIDENTIAL C MULTI-FAMILY O MOBILE HOME Q POOL/SPA O SIGN
SUBTYPE: O ADDITION 6 ALTERATION O DEMOLITION 0-f-LECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK 6 tAG
e�— 9-2 J
OCCUPANCY GROUP CONSTRUCTION TYPE
SPRINKLERS Q YES ONO
PROJECTADDRESS D N � J 6*/ P,Ao0 Q/Z 21P �o7S U7
ASSESSOR'S PARCEL NUMBER W01 5 LOT TRACT
OWNER NAME A^ A 0 o U (
ADDRESS 3 1 L RJo 2 SDI Fss J?
PHONE �a ��� S 9 7 - ' J 1 EMAIL
APPLICANTNAME
ADDRESS 5 - Su 4
PHONE A-S l -_A, EMAIL C-v_Q d 5-ZOo 111 1-011FJlaz-C p
CONTRACTOR'S NAME F/R S,fQ f`oA ; I/s2 OWNER BUILDER? O YES Cr-NO
BUSINESS NAME ,j eq £ V aA
ADDRESS S I J SF/ o(1-Sueq ^r1A /-, e" ius%4- Cf"A� 67
PHONE a Sl -a a y - y i 6/ EMAIL 4COS. U f/? P-e cell -.9/4 61/aR-C o yl
CONTRACTOR'S STATE LIC NUMBER O•2 lJ 6 L/ �� LICENSE CLASSIFICATION c fl
VALUATION$ /o v SQ FT L SO FT
APPLICANT'S SIGNATURE DATE /ss A u�
OTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CIT'OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE V5
INVOICE TOTAL I L-!q, Oy GREEN , •e� SMIP
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER Q YES O NO
City of Menifee Building & Safety Department 129714 Haut d. if CA 92586 (951)672-6777
If
www.cityofinenifee.ug y b O'utldill Ae
g Dept.
*
JUN 2 8 2018
Received