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PMT18-04206 City of Menifee Permit No.: PMT18-04206 29714 HAUN RD. Type: Residential Electrical MEN]FEE,CA92586 MENIFEE MENIFEE Date Issued: 08/27/2018 PERMIT Site Address: 26908 MIRABELLA CT, MENIFEE,CA Parcel Number: 360-480-054 92584 Construction Cost: $160.00 Existing Use: Proposed Use: Description of INSTALL UG ELECTRICAL 1/2"CONDUIT FOR FUTURE BBQ ISLAND&INSTALL NEW 15A OUTLET Work: Owner Contractor RITA CEPEDA , 26908 MIRABELLA COURT MENIFEE, CA 92584 Applicant License Number: 18-PEOP-00029 RITA CEPEDA 26908 MIRABELLA COURT MENIFEE, CA 92584 Phone: 9512395084 Fee Description Ply Amount IS1 Receptacle,Switch, Outlet&Fixture 2 121.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Electrical 1 6.05 $156.05 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_Templatexpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects with a licensed contractor(s)pursuant to the Contractors State License Law). I hereby affirm under penalty of perjurythat I am under provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractors State License Law for 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 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 this permit is issued. ww_ w.1e¢info. alaw. I. Q '7 Policy# " ' Date t7 a ` ❑I have and will maintain workers compensation insurance,as required by PROPE L ITY OWNERORA THORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which +)(By my signature below I certifyto each of the following:I am the property this permit is issued.My workers compensation insurance carrier and polity 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 with all applicable city and county ordinances and state laws relating to Carrier building construction.I authorize representatives of this city or county to Policy# Expires enter the age!iatffied ro erty for inspection purposes �7(This section need not to be completed is the permit is for one-hundred - Date T� 2 dollars($100)or less PRO ERTY OWNER—CpkUTHORIZED.AGENT ❑I certify that in the performance of the work for which this permit is issued, I shall not emolav any persons in any manner so as to became 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 Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or 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 XNo 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($500,000),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 o Yes 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) in Yes NA. 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 25S34 concerning Contractors License Law for the reason(s)indicated below by the hazardous material repo g. checkmark(s)I have placed next to the applicable items)(Section 7031.5 A,N �t Business and Professions Code).Any city or county that requires a permit s C to Date V construct,alter,improve,demolish or repair any structure,prior to its �PROPER OWNER 01 RRED 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)or that heorshe is exempt from Ilcensure 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($SOO). managers who do the paint-disturbing work themselves orthrough their o 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.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). Lode;The Contractor's State License Law does not apply to an owner of a 03 ❑An EPA Lead-Safe Certifi� aUlf will be responsible for this project property who,through employees'or personal effort,builds or improves the ,,,��,,,,,,tttttt��WWWIII property provided that the improvements are not intended or offered for CertifiegNgqTt•1\t (1� sale.If,however,the building or improvement is sold within one year of Firm Certdl'ca ion No.: completion,the Owner-Builder will have the burden of proving that It was 20— not built or improved for the purpose of sale. ❑No EPA Lead-Safe Cert irR+ s required for t i project because: -XII,as owner of the property am exclusively contracting with licensed H`�_ A 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 in EPA RRP rule please fill out the RRP Acknowledgement. ` BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE DATE: `6 Q i% PERMIT/PLAN CHECK NUMBER f GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES TYPE: O COMMERCIAL ORESIDENTIAL (E)MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: (E)ADDITION O ALTERATION O DEMOLITION ID ELECTRICAL O MECHANICAL O NEW OPLUMBING ORE-ROOF NUMBER OF SQUARES DESCRIPTIONOFWORK QI-CC+YIC 'L i ✓k-� -�-p }'��Q C•nCI Q OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERSOYES ONO PROJECTADDRESS 2i9go?, M)irCLDk8a 01_ . MMRnniA2-e CA ZIP ASSESSOR'S PARCEL NUMBER JLQ� Drw 4 LOT TRACT OWNER NAME � tt � II ADDRESS 2(pg0 it IP )0. C7. R 4R 125b PHONE l - Z,39 5�8�( EMAIL LOr> + APPLICANTNAME I+,3L ADDRESS 2(.0 i Y GL.b4 ) P_h I Q.Q .41 PHONE 23ci - t::�p?j z( EMAIL r-Cgg2cjcxvy1c1, I - cu"I CONTRACTOR'S NAME (� OWNER B� ER? YESUNO BUSINESS NAME Yl I 1 Ca S C (0 Yl ADDRESS M urr I -q CA ZJ�3 PHONE C151 -Z.) -Ir� - �6 B to yo EMAIL n+l I Co n,S YY1Ctt CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ I (0r.-OD SQFT L5QFT APPLICANT'S SIGNATURE DATE �� CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION ACCEPTED B` CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING GINEERING FIRE INVOICE TOTAL 06- GREEN SMIP —• OWNER BUILDER VERIFIED 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.cityofmenifee.us CitY Of Menifee ' Building Dept. AUG 2 ? 2018 L.L._. n0� M>t2 A g -. . ............ - --- - - ANo > 01-71 au too - - — 'a s -- - -_ -- - — --- --- ...... -- - City of Menifee Building Dept. - - - - - -AUG 21 2018 ---- --Received -- -- _ -- -^- ---- - . - ----------