PMT15-01070 I
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City of Menifee Permit No.: PMT15-01070
29714 HAUN RD. Type: Commercial Electrical
T MENIFEE, CA 92586
MENIFEE Date Issued: 04/29/2015
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PERMIT
Site Address: 29991 BERRYESSA DR, MENIFEE, CA Parcel Number:
92584 Construction Cost: $500.00
Existing Use: Proposed Use:
Description of INSTALL ONE 200 AMP UNDERGROUND TEMP POWER POLE TO SUPPLY POWER FOR
Work: CONSTRUCTION OF TRACT HOMES
Owner Contractor
STANDARD PACIFIC HOMES S R BRAY LLC
15360 BARRANCA PKWY 1210 N RED GUM STREET
IRVINE, CA 92618 ANAHEIM, CA 92806
Applicant Phone: 7145071881
MIKE MCGEE License Number: 980589
S R BRAY LLC
1210 N RED GUM STREET
ANAHEIM, CA 92806
Fee Description O�rt Amount
^-wee,-s.aw>n�tw^muy�.' �.' 1 �- �.w^Rs•"#�i3'1',78"di^7+`:""E»3 qa
Services, Switchboards, Control Centers& Panels _ 1 116.00
Additional Plan Review Building 148 148.37
$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 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.rpt 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
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 Cl 0 License No. '9,R5 "I who builds or improves thereon, and who contracts for the projects with a
Expires 11.3/h 7 Signatures 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 fallowing 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. 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:hftr),I/www.leoinfo.qg.00v/calaw.htLnl.
permit is issued.My workers'compensation insurance carrier and policy number are:
Property Owner or Authorized Agent Date
CarrierXL SAtia4_;
Expires 3/1 ///(o Policy# C
❑ 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-
0 1 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 r
subject to the workers'compensation provisions of Section 3700 of the Labor Property Owner or Authorized Agent Date
Code,I shall forthwith comply with those provisions.
City Business License# 0 L ; ,;O�
Date; 4'/ZTA_ 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,. AYES 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 V�O 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
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address IRNO 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, j(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 I HAVE READ THE HAZARDOUS MATERIAL
provisions of the Contractor's Slate License Law(Chapter 9 (commencing with INFORMATION GUIDE AND THE SCAQMD PERMITTING
Section 7000)of Division 3 of the Business and Professions Code)or that he or ES
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($500).) CODE SECTION
ION 25505RIAL ffE5533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole
compensation,will do( )all of or( ) porting of the work, and the structure is PROPERTY OWNER D AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property Y
who, through employees' or personal effort, builds or improves the property, —
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
PERMIT/PLAN& SAFETY APPLICATION
Menifee
DATE -IIIZ71/,$' PERMIT/PLAN CHECK NUMBER r 07I S— V O-70
TYPE: C,COMMERCIAL d"v RESIDENTIAL 0 MULTI-FAMILY t% MOBILE HOME u POOL/SPA SIGN
SUBTYPE: O ADDITION C7 ALTERATION O DEMOLITION *ELECTRICAL OMECHANICAL
O NEW O PLUMBING ORE-ROOF
APPLICATION NAME
DESCRIPTION OF WORK INS'_1A1_L ONc 20D fV_`r btJ6 ! 106 Po4,45 "7a sua'
PROJECTADDRESS %�qq% A 77
ASSESSOR'S PARCEL NUMBER LOT -7 TRACT
OWNER NAME 57,4N.Ao<.I) ,4611-/C I101t-rSS
ADDRESS 15.3 p 6Ate.emc4 ,okay, /RUive CA 94,
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE ` - 95 /^ Z73-"/33J EMAIL * AlI.&,-McP6uc,<PLU-5. C44,
CONTRACTOR'S NAME ,5;�, 6 y 4.L;C Wq 0L,14QPLaS OWNER BUILDER? 0 YES kNO
BUSINESS NAME
ADDRESS / /0 N196b GCUM `12&
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER 98D,y Cori LICENSE CLASSIFICATION C)b
VALUATION$ SOD.LV SQ FT L SQ FT I
APPLICANT'S SIGNATURE DATE '%/1 Z7//.�
DEPARTMENT DISTRIBUTION CITY OF MENOIFEfi�U$fyES L$ ICENyrNUMBER
BUILDING PLANNING ENGINEERING FIRE SMIP I GREEN -��LLJJ�J`!'��,
INVOICE C� PAID AMOUNT
AMOUNT \ :?CASH vCHECK# 0CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT '-!CASH CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO LICENSE NUMBER NOTARIZED LETTER 0 YES .0 NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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