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PMT18-03643 City of Menifee Permit No.: PMT18-03643 29714 HAUN RD. MENIFEE, CA 92586 Type: Residential Electrical MENIFEE MENIFEE Date Issued: 07/23/2018 PERMIT Site Address: 28981 W WORCESTER RD, MENIFEE, Parcel Number: 339-141-005 CA 92586 construction Cost: $2,000.00 Existing Use: Proposed Use: Description of REMOVE EXISTING FLOURESCENT LIGHTING IN 100 SQ FT KITCHEN, INSTALL 7 NEW LED Work: RECESSED LIGHTS, DRYWALL AS NEEDED Owner Contractor JOHN RANDALL SUNRISE HOME REMODELING INC 28901 W WORCESTER RD 4804 LAUREL CANYON BLVD#147 MENIFEE, CA 92586 VALLEY VILLAGE, CA 91601 Applicant Phone:8777109770 MANUEL JIMENEZ License Number:892162 4804 LAUREL CANYON BLVD#147 VALLEY VILLAGE,CA 91601 Fee Description City Amount 1S1 Receptacle,Switch,Outlet&Fixture 7 146.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Electrical 1 7.30 $181.30 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_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 Contractor's State License Law for Professions Co my license is in full farce and effect. �J the following reason: License Class�5 Li se No ` By my signature below I acknowledge that,except for my personal residence Expires -E2/ i 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 ❑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 Cade,for the performance of work for which WWW.Ieginfo.ca.gov/calaw.html- this permit is issued. Policy# Date ❑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 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 �r� �� with all applicable city and county ordinances and state laws relating to Carrier �i�' �� ///(l -7 /el building construction.l authorize representatives of this city or county to Policy# / z��s��(G��Expires [O — Z/ % 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 employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# 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 of the Labor Code,I shall f with mpI ith those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant Date7�23��y mixture containing a hazardous material equal to or greaterthatthe ' amounts spec red on the Hazardous Materials Information Guide? WARNING:FAILURE K 'SECURE WORS COMPENSATION COVERAGE 15 ❑Yes UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will theft tende_d use of the building by the applicant or future building_ AND-OVICFINESUPTOONE 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 Air Quality Management District(SCAQMD)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY ❑Yes e"o 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 boun fy of a school? (Section 3097 Civil Cade) ❑Yes f9 No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that)am exempt from the permitting checklist.Iunderstand my requirements under the State of Contractor's License Law for the reason(s)Indicated below by the California Health al Safety Cade,Section 25505 and 25534 concerning haz rdous material reporting-. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 �s ❑No �/7 t—�) Business and Professions Code).Any city or county that requires a permit to ////"""",,,, 2� Date/ �� —/U construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNS RAUTHORIZED T 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 fRRPI 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 complywith 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 ❑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( )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 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: ❑I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractor's State License Law does not apply to an owner of @ If your project does not comply with EPA RRP rule please fill out the RRP suh rt%C Acknowledgement. +h% -m R.enwAirl BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE DATE:-Z_�3 —/g PERMIT/PLAN CHECK NUMBER ?tooTTit—o GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES TYPE: O COMMERCIAL XRESIDENTIAL 0— MULTI-FAMILY O MOBILE HOME O POOL/SPA OSIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK /k5 . t/UO OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERS 0 YES XNO PROJECTADDRESS Z£Sy'�J Uj U)A&� E6 ZIP QZ�C84�2 ASSESSOR'S PARCEL NUMBER 3M- , .Qp5 LOT Oki TRACT OWNER NAME jx`{7t/ l�,4m LL ADDRESS Z S -0 j 0 Rb PHONE �f)-1 Z. EMAIL APPLICANT NAME �Z ADDRESS 3ol S Do,Ws PG- -PHONE 323-7D7- 5_7S3 EMAIL /6(V-2 P11-pei Lv CONTRACTOR'S NAME ' �jl/4(.J (Cj i � r I j�'(�At'� OWNER BUILDER? ^YES D BUSINESS NAME fpb ` / / goV " '� ADDRESS ��-�'� U( PHONE ZG-;Z - Y7 EMAIL 2-0&f�q-2 ,2sa./ CONTRACTOR'S STATE LIC NUMBER �qZ/ 67�- LICENSE CLASSIFICATION VALUATION$ C�eao, SO FT L SQ FT APPLICANT'S SIGNATURE DATE i DEPARTMENT DISTRIBUTION ACCEPTED BY� CITY OF MENIFEE QUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE •r/ INVOICE TOTAL ` $ �u GREEN SMIP 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 no www.cityofinenifee.us ^'l