PMT15-00495 i
City of Menifee Permit No.: PMT15-00495
29714 HAUN RD.
MENIFEE, CA 92586 Type: Mobile Home
MENIFEE Date Issued:
03/05/2015
PERMIT
Site Address: 33626 ZEIDERS RD, MENIFEE, CA 92585 Parcel Number: 384-150-003
Construction Cost: $3,000.00
Existing Use: Proposed Use:
Description of INSTALL TEMPORARY CONSTRUCTION TRAILER WITH TEMP POWER POLE AND 200A METER
Work:
Owner Contractor
ZEIDERS ROAD BUSINESS PARK OLTMANS CONSTRUCTION CO
3250 VISTA DIEGO ROAD 10005 MISSION MILL ROAD
JAMUL, CA 91935 WHITTIER, CA 90608-0985
Applicant Phone: 5629484242
STEVE OLTMAN License Number: 86393
OLTMANS CONSTRUCTION CO
10005 MISSION MILL ROAD
WHITTIER, CA
Fee Description Oft Amount
t
Services, Switchboards, Control Centers&Panels 1 183.00
$450.72
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 building 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.rpl Page 1 of 1
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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 j
Professions Code�nd Qmy license is In full force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class 7WAG Licens No. /e3 3 who builds or improves thereon, and who contracts for the projects with a
Expires._.S;m/linl_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
❑ 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
❑ 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:bttp://www.leoinfo.ca.aov/calaw,html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier —/RAV LEIIItS Property Owner or Authorized Agent Date
Expires z1• f 2 go/IT Policy# 07—e2j�P.R T7g7`,g9 70
❑ 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 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
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; City Business License#
WARNI G: FAILURE TO / SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONEHUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, LIVES OCCUPANT HANDLE A HAZARDOUS 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 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 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($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL IAEPORI'ING.
compensation, will do( )all of or ( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044, Business and Professions Code;
The Contractor's Stale License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not Intended or offered for sale. If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
&- Menifee
DATE J?^S" �j� PERMIT/PLAN CHECK NUMBER \5 -
TYPE: COMMERCIAL ❑RESIDENTIAL ❑MULTI-FAMILY OBILE HOME POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION�4LTERATION []DEMOLITION ,ELECTRICAL ❑MECHANICAL
❑NEW ❑PLUMBING [IRE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK .TA..Ps rAL a
AAjb 2MA 2001,11kI 2 0 AJE775 to-,
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER jN 3W-/50- 0o3 LOT TRACT
OWNER NAME 04:r AJS I:::� d Aj4C7 <440
l p
ADDRESS/p/ ,� O "I ` jo
PHONE Sfo'L• 9l/�y2 /jZ EMAIL /
APPLICANT NAME /Lf N j. 01- ^AS ` a1111 STiP
ADDRESS Q /d S CJ d• M! 4. 7.0,c b
PHONE 409 731 addOf. S, EMAIL y
CONTRACTOR'S NAME L Yf/•�•J CDI�lsJA. �' OWNER BUILDER? [jTS'ES❑NO
BUSINESS NAME ^./ edNj
ADDRESS IDOQ ,+1- w, P7 JMfF7'sjfjL
PHONEU2`919g "Lj' 2 2. Q EMAIL .STF�� l72 A"S.
CONTRACTOR'S STATE LIC NUMBER B�p 39 LICENSE CLASSIFICATION
VALUATION$ 0CFtr— Sil FT L SO FT
APPLICANT'S SIGNATURE —ILDATE .3 S � �•j
FTYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT 'CASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH C%CHECK# ::CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES C' NO DL NUMBER NOTARIZED LETTER O YES 0 NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-245-6213
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Oltmans
CONSTRUCTION CO.
February 17, 2015
City of Menifee
29714 Haun Road
Menifee, CA 92586
Re: Letter of Authorization
To Whom It May Concern:
Please consider this letter an authorization for Stephen Miller to sign all necessary
documentation to obtain any and all necessary permits on behalf of Oltmans
Construction Co.
Thank you in advance for your cooperation. Should you have any questions, please do
not hesitate to contact me.
Very truly yours,
OLTMANS CONSTRUCTION CO.
�Jam D. oo ide
Vi President
10005 Mission Mill hood P.U. Box 985 Whittier.CaliFoinin 90608-0985 562.948.42-11
I,ice,iisc No. 80393 AB l
!
1
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189
-------------
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness,accuracy,or validity of that document.
State of California )
County of Los A\
On Ee y- —Z S before me, L u,�rrn. Ac orn nit
Date Here Insert Name and Title of the Officer
personally appeared u,< �s
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(sT whose name(q is/are-
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
hls/TierAhelr authorized capacity(iss), and that by his/ber/thigir signatures)-on the instrument the person(s),
or the entity upon behalf of which the persort(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
LAURA on# MANIZ
20
Commission 205121297 Signature
Notary Public-California z
z Los Angeles County ' gnature of Notary Public
M Comm. Expires Jan 5 2018
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document Gi o� Chur\j _
Title or Type of Document: $)-cYmtn oAt2 �t yo kr• N Document Date: 2,
Number of Pages: { Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: Signer's Name:
❑ Corporate Officer — Title(s): _ ❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General ❑ Partner — ❑ Limited ❑General
❑ Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact
❑Trustee ❑ Guardian or Conservator ❑Trustee ❑ Guardian or Conservator
❑Other: ❑ Other:
Signer Is Representing: Signer Is Representing:
02014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item #5907