PMT15-02453 1
11
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City of Menifee Permit No.: PMT15-02453
29714 HAUN RD.
';ICCEI./�"'-,' MENIFEE, CA 92586 Type: Commercial Electrical
MENIFEE Date Issued: 0 812 512 01 6
9
PERMIT
Site Address: 27745 NEWPORT RD, MENIFEE, CA Parcel Number: 360-080-053 y
92584 Construction Cost: $4,000.00
Existing Use: Proposed Use:
Description of 200 AMP METER POLE, 100AMP 8 SUB PANEL
Work:
Owner Contractor
RICH DEVELOPMENT ENTERPRISES, LLC ANDY GUMP INC
1000 N WESTERN AVE.#200 26954 RUETHER AVENUE -
SAN PEDRO, CA 90732 SANTA CLARITA, CA 91351
Applicant Phone: 6619773851
MENIFEE, CA License Number: 357789
Phone: 9492890149 -
Fee Description
(3yl Amount f$1
tSe�ulce SWltchboaCcls ControlyCenteis&Panels `µ�k F,�}, �`F, �N Rr� a,�, 1 647
Building Permit Issuance 1 27.00
agtldlhor, IPlalj��evie Bulldln9 ,u�y y ?c, .pF =i '�! 4a ,s � Yr� ;_ 3
a..s.., .... �.,.,�
GREEN FEE 1 1.00
$1,823.37
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_Blda_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 and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class License No, who builds or improves thereon, and who contracts for the projects with a
Expires 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, 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:httc//www leg info ca gov/calaw html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Property Owner or Authorized Agent Date
Carrier O(A 2AQ0b1 c ( yea sce
Expires 7'-1-`I(ez Policy# f�.1c,W rh2'Lj�(cs
,� 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 emolov 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 Property Owner orz uthorized Agent Date
Code,I shall forthwith comply with those provisions.
_ City Business License#
Date; �Vie(^IS 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, ❑YES 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
INFORMATION GUIDE?
I hereby affirm that under the penalty of perjury there is a construction lending
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 OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address X NO 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 reasons)indicated below by the checkmark(s)I have placed OYES 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 State 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 DYES
she is exempt from licensors 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
EC M N 25505,
550 R P533�I AND 25534 CONCERNING
❑ 1, 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 OR AUTHO ZED 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 CITY OF WNIIFEE
Building & Safety Dept. PLCKNo: perm,,l�,No:
Y%—rlS
AUG 1 3 2015 29714 Haun Road Date: Dale:
Menifee, CA 92586 !;Z i
Phone: (951)672-6777 °°n` mount:
Received Fax:(951)679-3843 Ck# Ck#:
Building Combination Permit
To Be Completa By
Applicant
Legal Description P ann ng Case; F: Rt: R:
Property-Address:y Z't��-S Gt�T - .es or's Parcel_�re®
Proj,eq.,enant et-= Unit N: Floor#
Name: RICH DEVELOPMENT ENTERPRISES, LLC jPhoneNo. Fox No.
ProOwner ty Addreaa'1000 N WESTERN AVE,#200 SAN PEDRO, CA 90732 1 unit Number 71p,Code
Email Address:
Name:: MANNY HERNANDEZ Ph°`�-W49-289-0149.FoxNo.
,A ll 'A , ._._
pp cool Address: Unit Number Zip Code -
EmailAddress: - - - -
TPADMIN ANDYGUMP.COM
Name. ANDY GUMP, INC.
Phone�lq,1-310.-2145 Fax" 61-97 -0052
Contractor address; 26954 RUETHER AVE SA AbCbLARITA ""CA Z1p"091351
Contractor's of us ness Limnse No. Contractor' '' -- f-California License No. Clasaigcmion: O
03 460
r-i
:Numbest Squares:
Square Footage
nt
Desatptionofwarki INSTALL TEMP POWER POLE Coatarwork. �:¢�
Appllrant'sSignsturs Date:. V -
r Pfie C ( �� .
ZQ ompletetl:. XJt1/,:§fAtf.C. IY
-- - Indimle As R.Ro lvedor N/A-Not Applicable
5 Completes sets of fully dimomioned;drawn to sale plans which Include: l set of documents Which Include
❑ Ttle Sheet ❑ Elevations ❑ Electrical Plan -❑ Goo Tech/Solle Report(an cal only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑- Title 24'Energy(on S%x 17)
Foundation Plan ❑; Cross Section ❑ Plumbing Plan ❑ SWcturalCalouletions
-❑ Single Une diagram for elec.services over 00 AMP
13 Floor Plan__ . ❑ Strclum7FremJng Man&Details ❑ Shodng Plan I.Ej Bound Report-Resideptlal
Class Code: Indicate New Constructlon AReragon• Addition' MeanslMothads
Work Typo. Repak' Lj Retrofit• Revtvbnto Wling Period'Required? YES NO-
Proposed Building Use(s): Existing Building Uw(s):
#Buildings #Units: '#Stores: WI8 the Building Have a Basement? y of N
'Bldg,Code Occupancy Group Indicate Indicate 11- YES or NO -Indicate all Geo-tech.Ham Zone
At Project Construction SprinlUaratl that apply. Coastal Zone
Completion: Type(s): Colo YEB ar NO Noise Zone
Required?
Listed On Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: -- _„ Costal Commiss [Arch.Review Board Landmark Co Planning Camm.Zoning Adminlslrator
Fee Exempt - City Project Efec.Vehicle'OhergeF Landmark BelsWeRetroN oindei--`cwg.
Agnmi
Expedite:Projecl(s): Child Care City Project I Affordable Housing
For Staff Use Only -
aullomol6aroty I Pehni Speowust I Cly planning. Civil 15nfiln.c.ng PWM- inI Iranspam on gml.' 'Real Control'.
THANK YOU FOR HELPING US CREATE ABETTER COMMUNITY