PMT14-01973 City of Menifee Permit No.: PMT14-01973
29714 HAUN RD. . Type: Commercial Electrical
CCEL%� MENIFEE, CA 92586
MENIFEE Date Issued: 0 810 812 01 4
'1
a
y
9
PERMIT
f
Site Address: 29850 MC CALL BLVD, MENIFEE, CA Parcel Number:
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, CA 92806
Fee Description Qty Amount I$1
Building Permit Issuance 1 27.00
e
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 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
I
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 force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class Gt o License No. ll8b s`&`t who builds or improves thereon, and who contracts for the projects with a
Expires 31 ( Signature "`� licensed contractors)pursuant to the Contractors State License Law). j
WORKERS'COMPENSATION DECLARATION
❑ 1 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, cannot legally self a structure that I 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
s!eI have and will maintain workers' compensation insurance, as required by Business and Professions Code,is avallable upon request when this application is
ion 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http://www.ieainfo.ca.aov/calaw.html.
permit is Issued.My workers'compensation insurance carrier and policy number are:
Carrier XL SP1'C\NL-i'i Property Owner or Authorized Agent Date
Expires 'Ahl f� Policy# GvJGI Lid R307
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-
67,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
workers' compensation laws of California, and agree that if 1 should become
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; Ih Applicant; ?N City Business License# 6 75—H 2-S
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 HANDLEA HAZARDOUS MATERIAL ORA
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 AYES 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 items)(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 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 ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than ($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL ffEPORI'ING.
compensation, will do ( )all of or( ) porting of the work, and the structure Is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's Slate License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF ly'1E IIFEE PLCK No; Pe N
29714 Haun Road 7)
Date: Date:
Menifee, CA 92586
Phone: (951)672-6777 Amount- d� Amount:
Fax:(951)679-3843 Ck#: Ck#:
Building Combination Permit
To Be Completed By Applicant
Legal Description: ELEC-Ri �®F-STq L plannin Case: F;
MET�K 9 L: Rt: R:
Property Address: Assessor's Parcel Number.
2.'18Sv c-Cat'i 3LQD
ProjectfFari Name: T Unit#: Floor#:
5R�Dg42D 4Ac1 FI� - N ER t To,(f,� LRIc�
Name- TAi,30A ® Phone No.
Property 5 PACI FIB C®�� Fax No.
p y Address: e®,R6w
Owner ZS� �, /A1 Ce3fj - # '�® �A Unit Number Zip Code 7
Email Address:
Name: Phone No.
OWEp �t.V� Fax No.
Applicant Address: i®E.n 6l 911d-Z31-8�q
27� � 1IIetS LSD. r CIA, Unit Number Zip Code
Email Address:
SL�S�/, QCh�1�. PLUS . CGM
Name:
Pd WEB PL%S Phone No. Fax No.
't ttA-z3\—cad9
Contractor Address: C City � St ZipZip Code
27� N. '�E2Q1S gLJ0, 1�£V(daS Pt Q�\antractor s ily Business UnCense No. Contractor's City State of California License No.
Classi5cation: C.la
Number of Squares:
Square Footage
Description of Work: �NSTAtL.,L ®OA^P M y� Cost of Work:$
Applicant's Signature �lo��1 Y
=To se G&npieted By City5ta8 Only,' - -
indicate As R-Received or N/A-Not Applicable
5 Completes Sets of fully dimensioned,drawn to sale plans which include: t set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 54 x it)
,. ❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Structural Calculations
❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan iS Details ❑ Sharing Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition' Means/Methods
Work Type:HRepair' Retrofit* Revision to Existing Permir Required? YES NO
Proposed Building Use(s): Existing Building beats):
#Buildings. #units: #Stories: Will the Building Have a Basement?
Y of N
Bldg. Code Occupancy Group Indicate if
At Project Indicate YES or NO Indicate all Geo-tech.Here.Zone
i Construction Sprinklered thata [��Coastal Zone
Completion: apply:
Type(s): C of O YES or NO Noise Zone
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commas Arch.Review Board Landmark Comm. Planning Comm. Zoning Administrator
Fee Exempt: City Project on.Vehicle Charger Landmark Seismic Retroft pedal Case'.Bldg.
O((cialA royal
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Building/Solely Permit Specialist City Planning Civil Engineering EPWM-Admin Trans ortation M mt.P 9I Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
GATE C®M�� T3 SZ
Standard Pacific Homes
TRACT 34406
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