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PMT18-04353 City of Menifee Permit No.: PMT18-04353 29714 HAUN RD. /0 MENIFEE, CA 92586 Type: Residential Electrical MENIFEE MENIFEE Date Issued: 0 910 412 01 8 PERMIT Site Address: 28703 PASEO DIABLO, MENIFEE, CA Parcel Number: 341-082-010 92587 Construction Cost: $600.00 Existing Use: Proposed Use: Description of REPLACE 100A MAIN PANEL UNIT WITH SAME SIZE AND SAME LOCATION Work: Owner Contractor DEREK BLACK , 24320 S.CANYON MENIFEE, CA 92587 Applicant License Number: DEREK BLACK 24320 S.CANYON MENIFEE, CA 92587 Phone: 9512648207 Fee Description ON Amount IEI 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 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_Permil_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 perjurythat I am under provisions of with a licensed contractors)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and JIIIl am exempt from li sur er the Contractor's 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 m g p y 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 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 of work for which l . _ this permit is issued. www. ca. ou [mI. Policy# Date ❑I have and will maintain workers compensation insurance,as required by PROIVERTY 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 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.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 tli above ide tifi property br inspection purposes. (This section need not to be completed is the permit is for one-hundred I Date dollars($100)or less PR PERTY OWNER OR AUTHORIZED AGENT ❑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 CITY BUSINESS LICENSE# worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECIARATION subjectto 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 greaterthat the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes Po 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(SCAQMD)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines CONSTRUCTION LENDING AGENCY ❑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) ❑Yes -*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.I understand my requirements under the State of California Health&Safety Code,Section 25505 and 25534 concerning Contractors License Law for the reason(s)indicated below by the hazardous ma enal reportin checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 rpses ❑ g. 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(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 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 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($500). f��5 3 managers who do the paint-disturbing work themselves or through their 01 as ownel'bfthe 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 d�yww.eoa,Coy/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions r,g(Y�f'j-800-424-LEAD(5323). Code;The Contractors State License Law does not apply to an owner�o,��II ON l�� Ve90 An EPA Lead-Safe Certified Renovator will be responsible for this project property who,through employees'or personal effort,builds or imprdyPS 1VOI9 ��LLpp property provided that the improvements are not intended or offered f rLo`tl Certified Firm Name: sale.If,however,the building or improvement is sold within one year of �� oIk 11.• um Certification No.: completion,the Owner-Builder will have the burden of proving that it was --A not built or improved for the purpose of sale. d-Safe Certified Firm is required for this project because: `1Q,as owner of the property am exclusively contracting with licensed Ge contractors to construct the project(Section 7044,Business and Profee Code:The Contractors State License Law does not apply to an owner o a If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE Af � DATE: PERMIT/PLAN CHECK NUMBER (V 7 PLANNING CASE NUMBER TYPE: O COMMERCIAL '*RESIDENTIAL O MULTI-FAMILY 0 MOBILE HOME O POOL/SPA O SIGN SUBTYPE: :%ADDITION O ALTERATION O DEMOLITION V'ELECTRICAL O MECHANICAL O NEW O PLUMBING 110 RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK �e_ uV`OL)V' 6c t ') 7 ((�� I 61 ^7 PROJECTADDRESS zf�703 Pet'7Ca IJial6 ZIP 1�5^&71' ASSESSOR'S PARCEL NUMBER '3y1-( P)7_-010 � TRACT OWNER NAME �G 61-),..cc ADDRESS Z S )CA 5-8 7 G PHONE f] /- Zlp41 ' 11 n1 EMAIL A, qdG CVG5v1V+Ions •CO APPLICANT NAME k //� �-q 7 ADDRESS / ZO S• / �4r+ (9Nl �r ��I7 fYG L *2 v cl PHONE [sl - Z-4/y-67CR EMAIL �I4C�G G�GjoIU�'1'D�5 •C� CONTRACTOR'S NAME OWNER BUILDER? YES 0 NO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION /�� VALUATION$ OD SQ FT Z/o7'v L SO FT .C.� ctO APPLICANT'S SIGNATURE CuL_ DATE 9'_I�L Z C16 CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGI EER/NG FIRE GYQ 15� INVOICE TOTAL I'- 9-tDI GREEN �/• I SMIP OWNER BUILDERVERIFIED VES 0 NO DRIVERS LICENSE# NOTARIZED LETTER 0 YES O NO City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777 www.cityofmenifee.us G_i"o> City of Menifee NIFQ Building Dept. SEP 0 4 2018 Received PLOT/SITE PLAN REAR PROPERTY LINE I \ 1 I i On OS ��aQe�S�\ea�eM�\be H \��p �eototede�am�slpeM� SP aQQ�016\0k," °°saeaom\eVo°' C.?+ City of Menifee (� Building Dept. Pr- SEP 0 4 2018 Received FRONT PROPERTY LINE Property Owners Name lJe,-, Property Address 7 q 7C 3 City of Menifee Building&Safety Department 29714 Haun Rd.Menifee,CA 92596 951-6 77-672-677 wwwcityofinenifee.us