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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. 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