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PMT18-03433 City of Menifee Permit No.: PMT18-03433 29714 HAUN RD. Type: Residential Electrical r MENIFEE,CA 9258E MENIFEE MENIFEE Date Issued: 07110/2018 PERMIT Site Address: 25474 DORVAL CT, MENIFEE, CA 92584 Parcel Number: 339-291-005 Construction Cost: $1,500.00 Existing Use: Proposed Use: Description of MAIN PANEL DERATE 200A TO 175A Work: Owner Contractor KIRBY HANSON COMPLETE SOLAR INC 25474 DORVAL COURT 1850 GATEWAY DRIVE SUITE 450 MENIFEE,CA 92584 SAN MATEO, CA 94404 Applicant Phone:8772994943 SARAH PRADO License Number:961988 COMPLETE SOLAR INC 1850 GATEWAY DRIVE SUITE 450 SAN MATEO, CA 94404 Fee Description O_yt Amount($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 carried 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_Permk_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)am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law). Chapter!)(commencing with section 7000)of Division 3 of the Business and o 1 am exempt from Iicensure under the Contractors State License Law for Professions Code and my license is in full force and�PffOect. ('{ the following reason: License ass l —I�� License No. ` `1�, By mysignature below l acknowledge that,exreptformypersanal residence Expires Signature �, in which l 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 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.le info.ca. ov w.htm. Policy# uthis permit is issued. �/� ci^ t' Date s' v�� O 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 o By my signature below l certify to each of the fallowing: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.1 have read this numb P � application and the information I have provided is correct.I agree to comply Carrier � /\A with all applicable city and county ordinances and state laws relating to ��,,(f]1 building construction.I authorize representatives of this city or county to Policy# )�n`�� Expires r— er the above identified roperty for inspection purposes.` (This section need not to he completed is the permit is forane-hundredo Date I dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT ❑I certify that in the performance of the work for which this permit is issued, Ishallnotemolov 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 workers compensation provisions of Section 3700 of the Labor Cade,I shcalgorthwith cc lywthth s/eprovisions. Will the applicant or future building occupant handle hazardous material or Applicant fGti1 \ L,�� —l�'-,� mixture containing a hazardous material equal to or greater that amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE W RKER'S[ MPENSATION COVERAGE IS o Yes O 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($300,000),IN occupant require a permit for the construction or modification from South IN SECTIODITION N 3 THECOSTLAB OF OR CODE,INTEREST, ADATTOGES AS REYSFEOVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist IN SECTION 37060FTHE LABOR[ODE,INTEREST,AND ATTORNEYS FEES forguidelines CONSTRUCTION LENDING AGENCY ciYes oNo 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&Safety Code,Section 2S50S and 2SS34 concerning hpza(dous material reporting, pp chsiness and I have placed next to the applicable that)(Section permit Date Business and Professions Code).Any city or county thatrequiresa permit to '"'CYIJYILYl1° construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER 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,REPAIR AND 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 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($SOD). managers who do the paint-disturbing work themselves orthrough their O1,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.eov/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. D 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. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION E.,: fl DATE: PERMIT/PLAN CHECK NUMBER PLANNING CASE NUMBER TYPE: O COMMERCIAL .,RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLU�MLBING O RE-ROOF NUMBER OF SQUARES 1 DESCRIPTION OF WORK PROJECTADDRESS =qlq 'po1 V I,t.Q coo - ZIP BuildingD 1 6� t ASSESSOR'S PARCELNUMB`E,R LOT TRACT JU OWNER NAME ` YJ ADDRESS a`S� LQU( eive PHONE EMAIL APPLICANT NAME 0�_, ADDRESS \ PHONE q`k lX MAIL cD CONTRACTOR'S NAME OWNER BUILDER? O YES ONO BUSINESS NAME Q ADDRESS 1` PHONE �!E,C `Q�� p� �\ EMAI c'_ ��W CONTRACTOR'S STATE LIC NUMBER \ O LICENSE CLASSIFICATION VALUATION$ � SQ FT L SQ FT `� 1 APPLICANT'S SIGNATURE DATE CITY STAFF USE ONL ._. DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE INVOICETOTAL .$0 GREEN SMIP k OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777 b�k -_. www.cityofinenifee.us