PMT14-01971 V
l
City of Menifee Permit No.: PMT14-01971
29714 HAUN RD.
MENIFEE, CA 92586 Type: Commercial Electrical p
MENIFEE Date Issued: 08/08/2014
i
p p�
P E R M I T
Site Address: 28897 HERITAGE LAKE DR, MENIFEE, Parcel Number:
CA 92585 Construction Cost: $3,250.00
Existing Use: Proposed Use:
Description of INSTALL 100 AMP ELECTRICAL METER PEDESTAL
Work:
Owner Contractor
S R BRAY LLC
1210 N RED GUM STREET
ANAHEIM, CA 92806
Applicant Phone: 7145071881
SHAWN LARSEN License Number: 980589
S R BRAY LLC
1210 N RED GUM STREET
ANAHEIM, CA92806
Fee Description OQt Amount 1$1
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
$359.37
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 slated,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 Bidg Permit Template.rpl Page 1 of 1
i
City Of Menifee
LICENSED DECLARATION
1
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 force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class Ct D License No. 9 kb s&`r who builds or improves thereon, and who contracts for the projects with a
Expires v 3l I Signature �"'�� licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from Iicensure 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, cannot legally sell a structure that have
permit is issued. built as an owner-building if it has not been constructed in its entirety by licensed
Policy# contractors. I understand that a copy of the applicable law, Section 7044 of the
saI have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
tlon 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto://www.leginfo ca aov/calaw html,
permit is Issued.My workers'compensation insurance carrier and policy number are:
Carrier k L SFeCtp.L Ty Property Owner or Authorized Agent Date
Expires /31� _Policy# 6,JJ G -7 0 q 307
Name of Agent Phone# ❑ By my Signature below, I certify to each of the following: I am the property
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-
I certify that in the performance of the work for which this permit is issued,I identified property for the inspection purposes. ,
shall not employ any persons in any manner so as to become subject to the , ,r
workers' compensation laws of California, and agree that if I should become 9W ,,7 & y
subject to the workers'compensation provisions.of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. Property Owner or Authorized Agent Date
Date; Applicant; �N City Business License# U 7� Ll 2S
1� J
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, DYES 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 DNO 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 DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
❑NO DISTRICT (SCAQMD)SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS GUIDE LINES
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 DYES 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, ❑NO 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
provisions of the Contractor's State License Law (Chapter 9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
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 Iicensure 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 ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL fkEPORTING,
compensation,will do ( ) all of or ( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044, Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF MENIFEE PLCK No: P it
29714 Haun Road
a t
Menifee, CA 92586 Date_ Date:
Phone: (951)672-6777 Anne'nn'0 ` Amount:
Fax:(951)679-3843 IC7#-:
Building Combination Permit
To Be Completed By Applicant
Legal Description: ELECT t� tFeAESTPi L 1-lannin Case.
R MET R 9 F:
Property Address: Assessor's Parcel Number.
2589-7 1+FR1rtl-6C_ �RkE pR\uC,.
Projecu tenant Name: --- Unit#: Floor#:
5TAaOWt, Qi4L1 Fa C - 14 E21 T�(oE p.AK�
Name: STA14DAF® PACIFIC COf2Q Phone No. Fax No.
Property Address:
Owner ZS',r E. RullocQl-) 'G�I, # 740 coltl I Unit Number Zip Code
Email Address: q?.q
77
Name:
®w�Q Pl.lDs Phone No. Fax No.
Applicant Address: 1aEhp-y 17ly-Z71-$��
27.5D � 4V(Ie IS Bu9D S, W/ Unit Number Zip Code
Email Address: �2 S�y
5L411tSSP3 tQ PO4EZ PLUS . cii
Name:
PO WGR- PLVS one No. Fax No.
—t114-2V,% Vd9
Contractor Address: C City
State Zip Code
27ST7 AI. ?F-eV gtmvfl, �0(4S A rT S L� g2� t1
o1—actor s City Busmess lcense o. Contractor's City State of California License No.
q Claasihcation: C.l i7
Number of Squares:
Square Footage
Description of Work:
t00tP ELEC`7°{IIChL yt76T'E 6l PEOfS Cost of Work:$ 5
Applicant Signature
Date: -7 Zcl IdN
*Tv 13e 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
7 rtle Sheet El Elevations ❑ Electrical Plan ❑ Goo Tech/Soils Report(on cd only) -
❑ Plot/Site Plan ❑ Roof Ptan ❑ Title 24 Energy(on 8 Y x 11)
❑ Mechanical Plan
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan El Structural Calculations
El Single Line diagram for elec services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan 8 Delete ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration` Addition' MeanslMethods
Work Type: Repair" Retrofit• Revision to Foisting Permit' ftequired7 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 if Indicate all Geo-tech.Haz.Zone
At Project Construction Spine lered YES or NO that apply: Coastal Zone
Completion: PP Y�
Type(s): i C Of O Noise Zone
Required? YES or NO
Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm,Zoning Administrator
Pee Exempt: City Project lElec.Vehicle Charger Landmark Seismic Retrofit pedal Case:Bldg,
Expedite Project(s): Child Care City Project Green Building 9 Landmark O(ncial A ,oval
Affordable Housing
For Staff Use Only
Builtling/Safety Permit Specialist City Planning Civil Engineering EPWM-Admin Transpodi I Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
FATE corgd T3 �-7_
Standard Pacific Homes
ice Off Ci-,O n� TRACT 34406
1— "Heritage Lake Backbone Ph IV"
Menifee, California
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LEGEND FIT� p
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Backbone W01 _ _ -GRAND A969ue
Backbone W02 CIe`l.
Backbone W03 t \`\v 0 '<'
M. E. Nollkamper,Inc. 940 Manor Way-Corona,CA 92882 .808.4645,Fax 51.737.9343
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