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PMT19-00112 City of Menifee Permit No.: PMT19-00112
A& 29714 HAUN RD. Type: Residential Electrical
MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued 01/09/2019
PERMIT
Site Address: 26350 RIM CREEK PATH, MENIFEE, CA Parcel Number: 360-670-001
92584 Construction Cost: $2,500.00
Existing Use: Proposed Use:
Description of UNDERGROUND ELECTRICAL CONDUIT 1"CONDUIT 71.8 L FT, 3/4"CONDUIT 293.3 L FT WITH 12
Work: AWG.4 LAMPS AND 4 OUTLETS-GAZEBO NOT PART OF PERMIT
Owner Contractor
MARK CANNON
26350 RIM CREEK PATH
MENIFEE, CA 92584
Applicant License Number:
MARK CANNON
26350 RIM CREEK PATH
MENIFEE, CA 92584
Phone: 951-880-7733
Fee Description PRz Amount ISl
Receptacle, Switch, Outlet&Fixture 8 151.00.
GREEN FEE 1 1.00
EleGtricai Line 1 116.00
General Plan Maintenance Fee-Electrical 1 7.55
$275.55
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 41 am exempt from licensure under the Contractor's Stat License Law for
Professions Code and my license is in full force and effect. t=in�gyre�a�s�on. a AA
License Class License No. By my signaturplpyrj aknoH ledge that,except or 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
this permit is issued ww�i� _ info.ca. ov w.hLir 1. p
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
Carrier
with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Expires-.... ante the abov ide ified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred r I ~7
dollars($100)or less Date
PROPER WNE OR AUTHORIZED AGENT FF
❑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 forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous materialequal to or greater that the
Applicant Date_ amounts sp/�ified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes 'IV0
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 for guideline
CONSTRUCTION LENDING AGENCY ❑Yes �.I 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 boundary of a school?
(Section 3097 Civil Code) ❑Yes In 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
Contractor's License Law for the reason California Health&Safety Code,Stiio 5505 and 25534 concernings)indicated below by the ha�ous rnateri WAUHO111111ED
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ha/O ❑N J 9
Business and Professions Code).Any city or county that requires a permit to Oesate
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRPI
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). 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 wwwwa.aoyllead 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 ❑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. ❑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 a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION M ENIFEE
DATE: 01/09/2019 PERMIT/PLAN CHECK NUMBER �Iv I 1 (� •��
GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: 0 COMMERCIAL 0 RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0. SIGN
SUBTYPE: ()ADDITION ®ALTERATION (0 DEMOLITION E) ELECTRICAL 0 MECHANICAL
(:)NEW PLUMBING QRE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK Electrical conduit for back yard and side yard. 4 01
OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERS O YES ONO
PROJECTADDRESS 26350 Rim Creek Path ZIP 92584
ASSESSOR'S PARCEL NUMBER �' Z LOT TRACT
OWNER NAME Mark Cannon
ADDRESS 26350 Rim Creek Path, Menifee, CA 92584
PHONE 951-880-7733 EMAIL mcannon354@gmail.com
APPLICANT NAME Mark Cannon
ADDRESS 26350 Rim Creek Path, Menifee, CA 92584
PHONE 951-880-7733 EMAIL mcannon354@gmail.com
CONTRACTOR'S NAME OWNER BUILDER? ■ YESONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION $ 2 j�,►� SQ FT L SQ FT
r APPLICANT'S SIGNATURE DATE 01/09/2019 �
CITY STAFF USE ONLV-v IF
DEPARTMENT DISTRIBUTION ACCEPTED BY: l� CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE "�(4-D
INVOICE TOTAL ''J� GREEN 1 .00 F-Smip
14F&
OWNER BUILDER VERIFIED YES '::: NO DRIVERS LICENSE# NOTARIZED LETTER YES C::= NO
IVI
City of Menifee Building &Safety Department 129714 Haun R uw ga 586 (951)672-677,
www.cityofinenifee.us
Received
Paradise Winters
From: Andrea Montes
Sent: Wednesday,January 9, 2019 3:06 PM
To: Paradise Winters
Subject: 26350 Rim Creek Path
Owner Information Photos Available 06/00/201
nmer Name: CANNON MARK R/CANNON KRISTINE L
ailing Address: 26350 RIM CREEK PATH,MENIFEE CA 92584-2794 R041
:sting Codes: HW//JT
Ci#y of Menifee
Building ❑e
pt
tieceived