PMT14-01862 a
City of Menifee Permit No.: PMT14-01862
29714 HAUN RD. Type: Commercial Electrical
't kCCJEIILA> MENIFEE, CA 92586
MENIFEE Date Issued: 07/24/2014
I
PERMIT
Site Address: 25643 MURPHY RANCH RD, MENIFEE, Parcel Number: 358-090-028
CA 92584 Construction Cost: $1,000.00 _
Existing Use: Proposed Use:
Description of TEMP POWER POLE 200 AMP
Work:
Owner Contractor
WOODSIDE HOMES BOLD ELECTRIC INC
11870 PIERCE STREET 2760 PROSPECT STREET
RIVERSIDE, CA 92505 CORONA, CA 92881
Applicant Phone: 9093403573
FRANK DANIELS License Number: 566067
BOLD ELECTRIC INC
2760 PROSPECT STREET
CORONA, CA 92881
Fee Description Qttv _ Amount f$1
e"Ae
Services, Switchboards, Control Centers&Panels 1 116.00
Building Permit Issuance 1 27.00
-
GREEN FEE 1 1.00
$486.37
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
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Code and my license is in full fogsondfeffCejcW 1-y Code:The Contractor's License Law does not apply to an owner of a property
License Class cr3 License No. JC�� 6 / who builds or improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Law).
Expires�^�•I Signature
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from licensure under the Contractors State License Law for the
❑ 1 hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in
compensation.,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have
permit is issued. )� —'7 1 , �( S built as an owner-building if it has not been constructed in its entirety by licensed
Policy# 6 �'1 1, contractors. I understand that a copy of the applicable law, Section 7044 of the
❑ I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the fallowing Web site:http//www.leginfo.ca.gov/calaw.html.
permit is issued.Mporkers'cclimperisation insurance carrier and policy number are:
Property Owner or Authorized Agent Date
Carrier— I �1
Expires � �^ ^ ' � Policy#
❑ By my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
construction.I authorize representatives of this city or county to enter the above-
El I certify that in the performance of the work for which this permit is issued,I identified for the inspection purposes.
shall not employ any persons in any manner so as to become subject to the
workers'compensation laws of Califomia, and agree that if I should become
subject to the workers'compensation provisions of Section 3700 of the Labor Property Owner or Authorized Agent Date
Code,I shall forthwith comply with thosa pu uision .
�7 City�� ,r, Business License d J
Date; l T Applicant;
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, []YES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES C<Q EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending
INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address 140 DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed []YES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s)(Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, CIRO SCHOOL?
or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the I HAVE READ THE HAZARDOUS MATERIAL
provisions of the Contractor's State License Law (Chapter 9 (commencing with
Section 7000)of Division 3 of the Business and Professions Code)or that he or DYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to -eNO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECOUS IONMAT 25505RIAL �E5533 AND 25534 CONCERNING
❑ 1, as owner of the property, or my employees with wages as their sole
G.
compensation,will do( )all of or( )porting of the work, and the structure is PR NER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X 6
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF MENIIFA�ng & Safety Dept. PLCK No: Permit No: O1�
it of Menifee
29714 Haun Road JUL 16 2014 Date: oat
Menifee, CA 92586 1 Il9 LZ 1
Phone: (951)672-6777 Amount: Amount:
Fax:(951)679-3843 Received
Ck#: Ck#:
Building Combination Permit
To Be Completed ByApplli
Legal Description: Planning Case: F: L: Rt: R:
Property Address: /• - �� Assessor;S,P�cc umbe
!� ifc G>
P rojecUTenant Name: 1 Unit#: Floor#:
Name: y y„�Cl •r�e Ay.\�Q Phone Nf7l (c) 1 � Fax No.
Property 1
Address: I IC?rU r erCe Sr C4 Unit Number
Owner U 4
Email Address:
Name: f-r1'r\\/-N Dc4i e-I PonL ;� \-I � Fax No.
Applicant Address: �f U �V` C ,C �.!`�Un Unit Number J`'' Zip Code
Email Address: b J J W
Name: L� �L i C i W� Phone No.3(i� Fax No.
Contractor Address: -1(=0 �(�5 C_i (aj 3 1 � City Z--^�nh State Zip�dyq'Yz]'
Contractors Cray Busin s Contrra % r�s fjity�S��fa Callforr ia�.Lii-dense No Classification:
Number of Squares:
Square Footage
Description of Work: 1�(",\ Ucz Cost of Work:$ I QOQ I�J
Applicant's Signature Date:
to Be Completed By City Staff Only ;
Indicate As R-Received or N/A-Not Applicable
5 Completes sets of fully dimensioned,drawn to sale plans which include: 1 set of documents which include
❑ Ttle Sheet ❑ Elevations ❑ Electrical Plan ❑ Goo Tech/Soils Report(on cd only)
❑ Plat/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on t3'/:x 11)
❑ ❑ Structural Calculations
Foundation Plan ❑ Cross Section ❑ Plumbing Plan
❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan I ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration*
Addition' Means/Methods
Work Type: Repair' Retrofit` Revision to Existing Permit' Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: it Stories: Will the Building Have a Basement?
Y of N
Bldg. Code Occupancy Group Indicate Indicate it YES or NO Indicate all Geo-tech.Haz.Zone
At Project Sprinklered [hat a
Completion' Construction pply: Coastal Zone
Type(s): C of 0 YES or NO Noise Zone
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comrn. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit Special Case:Bldg.
Offi,-WApprowl
Expedite Projects): Child are City Project Green Building Landmark Affordable Housing
For Staff Use Only
BeilcimplSafety Permit Specialist City Planning I Civil Engineering EPWM-Admin Transporlalan etgmt. I Renl Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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