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PMT18-04174
City of Menifee Permit No.: PMT18-04174 29714 HAUN RD.Il MENIFEE, CA 9258E Type: Residential Electrical MENIFEE MENIFEE Date Issued: 08/2312018 PERMIT Sfte Address: 31940 TIMBERMAN CT, MENIFEE, CA Parcel Number: 360-581-024 92584 Construction Cost: $100.00 Existing Use: Proposed Use: Description of RE-ENERGIZE EXISTING MAIN PANEL Work: Owner Contractor TUOI TA 31940 TIMBERMAN COURT MENIFEE, CA 92584 Applicant License Number: TUOI TA 31940 TIMBERMAN COURT MENIFEE, CA 92584 Phone:7147160783 Fee Description Qtv Amount($) Meter Reset 1 116.00 Building Permit Issuance 1 27.00 General Plan Maintenance Fee-Electrical 1 5.80 $148.80 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_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 lcensure under the Contractors State License Lawfor Professions Code and my license is in full force and effect. the following reason: License Class License No. By my signature below I acknowledge that,except for my personal residence Expires 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 D 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 fallowing website: by Section 3700 of the Labor Code,for the performance of work for which www-leeinfo.ca.gov/calaw.html.permit is Issued. Policy If Date 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 ❑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: application and the information I have provided Is correct.I agree to comply Carrier with all applicable city and county ordinances and state laws relating to buildi constru tion.I authorize representatives of this city or county to Policy It Expires an the above entified property for inspection purposes. �7 (This section need not to be completed is the permit is for one-hundred Date D ✓L� dollars($100)or less .. PRO ERTY OW R OR AUTHORIZED AGENT a 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 CI BUSINESS ICENSE# 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 Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material Or a Applicant Date 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 Air Quality Management District(SC construction or See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo Coast Airlines Qua CONSTRUCTION LENDING AGENCY ❑Yes D 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) ❑Yes ❑No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAOMD 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 25505 and 25534 concerning hazardous material reporting. checkmark(s)I have placed next to the applicable Item(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 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(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 work that distulfied rbs and comply with thanApplicant 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 sale 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 Contractors State License Law does not apply to an owner of a D 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. o 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 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 „ MENIFEE �..�. 4 k DATE: PERMIT/PLAN CHECK NUMBER PLANNING CASE NUMBER TYPE: 0 COMMERCIAL RESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME O POOL/SPA C SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK f A,I &VV ire-St t - PROJECTADDRESS 'MAQD -TICVtibCAloJ l,Dt�1 / � ZIP City ot Menitee ASSESSOR'S PARCEL NUMBER 3LO0- 9g1 -_ LOT TRACT Building Dept. OWNER NAME IUDI I t-k ADDRESS 3Ictq b �vr✓f�r�Y vvl-/LJ �vt�i' if t[ q PHONE Cll�t)�1�Io-D"l�'3VICtyI[MI�edG EMAIL Receivec -{- UiLi.►�3�' APPLICANT NAME (/ `C.>` � ADDRESS $LtlaG Gi(AUjiKI StYItd CZ r' GI _' l �pF' cl 113L� PHONE t1+N)'�l�e-b�[�3 EMAIL CONTRACTOR'S NAME Na- OWNER BUILDER? O YES O NO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ OFT L SO,FT /� APPLICANT'SSIGNATUR r�/`� DATE �' '' !,OTY STAFF USE ONLY DEPARTMENT DISTRIBUTION {ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I INVOICE TOTAL I ` q, 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 www.cityofinenifee.us �"' �s. ENIFE Tuoi Ta City of Menifee 31940 Timberman Court Building Dept. Menifee, CA 92584 AUG 23 2018 8/22/2018 Received c/o: Building&Safety Department City of Menifee 29714 Haun Road Menifee, Ca 92586 To Whom It May Concern: This letter is a formal authorization for Tuan Ta, my Son to act on my behalf. In the purposes of obtaining a meter re-set permit, scheduling an Inspection,and meeting with Inspector. For my property located at 31940 Timberman Court, Menifee,CA 92584. If you have any questions, I can be reached at (714) 235-6507 or(949) 372-8874. 1 appreciate your help. Regards, Tuoi Ta CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE §1189 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 Riverside ) On August 22, 2018 before me, Marcia Garcia Notary Public Date Here Insert Name and Title of the Officer personally appeared Tuoi Hong Ta Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies),and that by his/her/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. MARCIAGARCIA WITNESS nd and official seal. o COMM.#2178874 NOTARY PUBLIC CALIFORNIA; Si nature d1 3 ORANGE COUNTY N g My COMM.ex*"Jan.8,2021 - Sign ure of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: AuthodutionLeaer for the City ofMenifee Document Date: August22, 2018 Number of Pages: 1 Signer(s) Other Than Named Above: Rita Sagistano Capacity(ies) Claimed by Signer(s) Signer's Name: Tuoi Hong Ta Sign ' Name: ❑Corporate Officer — Title(s): ❑Corpora fficer — Title(s): Partner — Ci Limited ❑General El Partner — El ' ed ❑ eral X Individual El Attorney in Fact ❑Individual ❑ e ey in Fact 0Trustee ❑Guardian or Conservator ❑Trustee Landis Conservator Ll Other: ❑ Other: Signer Is Representing: Signer epresenting: ,�,c('.`c�.'c2 etc(:�.r-4e(9�G�.'.G`r_Le.�'�L�i:�.eLQRrc:'cG�1�R�L.�Ccf)R�(c2.xt,¢Ro0'rz.�Jr-L`cc9e'<JaGCCx%6X ©2014 National Notary Association •www.NationaiNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907