PMT18-03287 City of Menifee Permit No.: PMT18-03287
29714 HAUN RD.
MENIFEE,CA 92586 Type: Residential Electrical
MENIFEE MENIFEE Date Issued: 07/02/2018
PERMIT
Site Address: 27685 BROOKSHIRE CIR, MENIFEE, CA Parcel Number: 336-462-010
Construction Cost: $61,950.00
Existing Use: Proposed Use:
Description of DERATE MAIN BREAKER TO 175A
Work:
Owner Contractor
RICHARD GREEN SEMPER SOLARIS CONSTRUCTION INC
27685 BROOKSHIRE CIR 1805 JOHN TOWERS AVENUE
MENIFEE,CA92585 EL CAJON, CA 92020
Applicant Phone:6197154054
1805 JOHN TOWERS AVENUE License Number:978152
EL CAJON,CA 92020
Fee Description Duet rr Amount 4$1
Services,Switchboards, Control Centers&Panels 1 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 3.00
General Plan Maintenance Fee-Electrical 1 5.80
$151.80
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 building 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_Bidg_Pemit 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 Ilcensure under the Contractor's State License Law for
Professions Code and my license is in II farce and effect _ _ __the following reason:
License Clas G lD - 1-
I License No. .S:2 By my signature below I acknowledge that,except fumy personal residence
Expires 10l?( Iy Signature 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
a 1 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 ofwork for which ,A„,ssy leeinfa.ca.emv/calaw.lttml.
this permit is issued.
Poliryq Date
, II 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 l certify to each afthe 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
Carrier
fJ�� 'N( _ ND with all applicable city and county ordinances and state laws relating to
building 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 PROPERTY OWNER OR AUTHORIZED AGENT
a l certify that in the performance ofthe work for which this permit is issued, ��p�y Q�/�
Ishallnotemolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE g c Jr v" , ,>
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 ofthe Labor
Code,I shall!r!t w"h comply with those provisions Will the applicant or future building occupant handle hazardous material or a
Applicant Date S mixture containing a hazardous material equal to mrgreater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE W 'S COMPENSATIO COVERAGE IS ❑Yes fsZn0
UNLAWFUL,AND SHALLSUBIECT 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 requires permit for the construction or modification from South
IN SECTION ON TO
06 OF
LABOR CODE,INTERTION,DAMADATTOGES AS R ATTORVIDEDNEYS
FOR Coast Air Quality Management District(SCAQM D)?See permitting checklist
IN SECf10N 37060F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guideli es
CONSTRUCNON LENDING AGENCY ❑Yes rJJv0
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) a Yes CNo
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 70315 hazardous material reporting.
Business and Professions Code).Any city or county that requires permit to Dyes a Date S /
construct,alter,Improve,demolish or repair any structure,priorto its p Ty OWNER ORAIIT D GEM
issuance,also requires the applicant for the permit to file a signed statement
thatheorshe is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter9(commencing with Section 7000)of Division 3 ofthe 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 basisnfor the alleged exemption.cisthapplicant
nviolation toci it Section of not by residence or childcare facility to be RRP-certified firms and comply with
than
Applicant fora permit subjects the appllcan[toactvil penalty of not more required practices.This includes rental property owners and property
than($SOOJ. managers who do the paint-disturbing work themselves or through their
al,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 ofor( )portion of the work,and the structure is www.eoa.eov/lead or contact the National Lead Information Centerat
not intended or offered for sale.(Section 7044,Business and Professions 1-900-424-LEAD(5323).
Code;The Contactors State License Law does not apply to an owner ofa ❑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. a No EPA Lead-Safe Certified Firm is required forthis project because:
o 1,as owner ofthe property am exclusively contracting with licensed
contactors 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