PMT14-03069 City of Menifee Permit No.: PMT14-03069
29714 HAUN RD.' CCli MENIFEE, CA 92586 Type: Commercial Electrical
MENIFEE Date Issued: 11/21/2014
PERMIT
Site Address: 27918 LADOGA DR, MENIFEE, CA 92585 Parcel Number: 333-180-029
Construction Cost: $500.00
Existing Use: Proposed Use:
Description of INSTALL ONE 200 AMP U/G 120/240V TEMP POWER POLE FOR TRACT PRODUCTION
Work:
Owner Contractor
STANDARD PACIFIC HOMES S R BRAY LLC
255 E RINCON ST#200 1210 N RED GUM STREET
CORONA, CA 92879 ANAHEIM, CA 92806
Applicant Phone: 7145071881
MIKE MCGEE License Number: 980589
S R BRAY 1-LC
1210 N RED GUM STREET
ANAHEIM, CA 92806
Fee Description Oft rr Amount 1$1
ni oa-. Po b
Services, Switchboards, Control Centers& Panels 1 183.00
Bu lding ern itua00
Additional Plan Review Building 148 148.37
GREEN FEE 1 1.00
$426.37
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.
As Bldg_Permit_Template.rpt 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 force ar).d_effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class G/0 License No, who builds or improves thereon, and who contracts for the projects with a
Expires 1 I Ts' Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from licensure under the Contractors'State License Law for the
❑ I 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
Section 3700 of the Labor Code, for the performance of work for which this which I must have resided for at least one year prior to completion of
permit is issued. improvements covered by this permit, I cannot legally sell a structure that I have
Policy# built as an owner-building If it has not been constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law, Section 7044 of the
-R' 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 following Web site:htlp:llwww leginfo ca govlcalaw htm1.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier XL-fi�fAL,jV llv_t r<4VCE
3�31) Date
Expires (5 Policy#
Name of Agent Phone# fY 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 1 have provided is correct. I agree to comply
one-hundred dollars $$100)or less) with all applicable city and county ordinances and slate 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
workers' compensation laws of California, and agree that if I should become --� J� Z �y
subject to the workers'compensation provisions of Section 3700 of the Labor Property Owner or Authorized A Code,I shall forthwith comply with those provisions. P Y gent Date
Date; 1_ ; —— City Business License#
�Z/ Applic —
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
($100,000), IN ADDITION TO THE COST OF COMPENSATION, WILL THE APPLICANT OR FUTURE BUILDING
AYES OCCUPMIXTURE
CONTAININGT HANDLE A ARDOUSHAZARD MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑NO 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 ❑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, ❑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 ❑YES 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 ($509).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORT 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 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).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee NOV 19 2014
DATE �n1 �� PERMIT/PLAN CHECK NUMBERWIT
(001
TYPE: •`., COMMERCIAL PRESIDENTIAL ) MULTI-FAMILY 0 MOBILE HOME POOL/SPA C) SIGN
SUBTYPE: (}ADDITION %ALTERATION 3 DEMOLITION (?'ELECTRICAL C. MECHANICAL
C, NEW t? PLUMBING 0 RE-ROOF
APPLICATION NAME
DESCRIPTION OF WORK INSTALL t; ZDO IW (A/( 1 Z 1'6V Tom+ XV ebW99 &L.E
Aw -To 7Ae R tzu la l4ivr
PROJECTADDRESS Z_? g`
ASSESSOR'S PARCEL NUMBER 1303'I LOT l� TRACT 3y Q
OWNER NAME STIIAN 6
2 �fFG1�"/G
ADDRESS 5/�. �1L6N 5T55#'2 0 CoAIN CA `3�79
PHONE 95-1-91p- 5z DO EMAIL
APPLICANT NAME /L41A�_ 1446, A!�
ADDRESS
PHONE �- r'ISI-Z53 1313EMAIL X41/4E11^e
CONTRACTOR'S NAME 5,< MAY LLC D3A P6Q4< LU ' OWNER BUILDER? OYES 4; NO
BUSINESS NAME
ADDRESS IZ1D /U, A�b Stm, AA),M//li 64 &(o
PHONE 711-- 7�5 EMAIL -
CONTRACTOR'S STATE LIC NUMBER C18058--J LICENSE CLASSIFICATION C/D
VALUATION $ 76b, D S FT L SQ FT
APPLICANT'S SIGNATURE �'�� DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE SMIP GREEN
INVOICE PAID AMOUNT
AMOUNT is CASH %'CHECK# C;CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT i. CASH C,CHECK# 'DCREDITCARD VISA/MC
OWNER BUILDER VERIFIED " YES O NO LICENSE NUMBER NOTARIZED LETTER i1 YES 0 NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Requesoffice'lCom
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