PMT15-03384 City of Menifee Permit No.: PMT15-03384
29714 HAUN RD. Type: Commercial Electrical
�A-CCELA-? MENIFEE,CA 92586
MENIFEE Date Issued: 11120/2015
PERMIT
Site Address: 25839 ROUNDUP CIR, MENIFEE, CA Parcel Number:
92584 Construction Cost: $445.00
Existing Use: Proposed Use:
Description of INSTALLATION OF 1 TEMP POWER POLE
Work: 200A
Owner Contractor
RICHMOND AMERICAN HOMES TEMP POWER SYSTEMS
5171 CALIFORNIA AVE#120 625 S FEE ANA STREET
IRVINE, CA 92617 PLACENTIA, CA 92807
Applicant Phone:7142235600
WAYNE MCCOY License Number.696713
TEMP POWER SYSTEMS
625 S FEE ANA STREET
PLACENTIA, CA 92807
Fee Description ORl Amount f81
Temporary Power Pole 1 67.00
Services, Switchboards, Control Centers&Panels 1 116.00
Building Permit Issuance 1 27.00
Additional Plan Review Building 148 148.37
GREEN FEE 1 1.00
General Plan Maintenance Fee-Electrical 1 9.15
$368.52
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 carded 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_Pennit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'State License Law forth(
I hereby affirm under penalty or perjury that I am licensed under provisions of fallowing reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence it
Professions Code and my license is in full force and effect. which I must have resided for at least one year prior to completion o
License Class tom ��!-Licen improvements covered by this permit, I cannot legally sell a structure that I have
Expires t o�31 I b Signature built as an owner-building If It has not been constructed in Its entirety by licenser
I I understand that a copy of the applicable law, Section 7044 of the
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application ie
submitted or at the following Web she:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: htto!/www.leainfo.ca.gov/calaw.html.
I have and will maintain a certificate of consent of self-insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the properly
C9-1 have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owners behalf. I have read thi:
section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comph
permit is issued.My workers'compensation insurance carrier and policy number are: 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
Carrier 15-rA7ts C-O"P• 1+-&- identified property for the inspection purposes.
Policy# 9 1 n S&I —t S' Expires /O/7 l/rp Date
Property Owner orAuthorized Agent
(This section need not be completed if the permit is for City Business License#
one-hundred dollars($100)or less)
❑ 1 certify that in the performance of the work for which this permit is issued,i HAZARDOUS MATERIAL DECLARATION
shall not emolov any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers'compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts speofied on the Hazardous Materials Information Guide?
Code,I sh Trate
comply with those provisions. DYES
3145
C=,.
Applicant; ; // 2Z�75' Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNING: TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND ❑YES 0
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary off chool?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES L O
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous ro Lrep 'ng.
OWNER BUILDER DECLARATIONS 0 Date //2�
I hereby affirm under penally of perjury that I am exempt from the Contractor's
//(
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY O ER AUTH RIZED AGENT
next to the applicable items)(Section 7031.5. Business and Professions Code: E RE OVATI PAIR AND PAINTING RRP Any city or county that requires a permit to construct,alter, improve,demolish,
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 The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law(Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit:
❑ I, as owner of the roe www.epa.gov/lead or contact the National Lead Information Center at
property,rty, or my employees with wages as their sole 1-800-424-LEAD(5323).
compensation,will do( )all of or( )porting of the work, and the structure is
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 ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the property,
Provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name:
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 Firm Certification No.:
Purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed ED No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
AkMenifee
DATE PERMIT/PLAN CHECK NUMBER15' O�
TYPE: CI LOMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION e'15 ECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK S oN tr- p
PROJECTADDRESS & Qovi.. v c.LG,
ASSESSOR'S PARCEL NUMBER 3 p>r I l o i Ll LOT 90 TRACT
PROPERTY OWNER'S NAME P_1611 O Me
ADDRESS -71 Q/)*L4POeojjA 4V6. 57'E.14 I b 04 - °ra I
PHONE 94,q- yU-1- oflcp0 EMAIL IV
APPLICANT NAME C S a
ADDRESS C p , . 9a9- O
PHONE -71y-aa3- "Wpm (err; 10F) EMAIL p c7
CONTRACTOR'S NAME p OWNER BUILDER? OYES O
BUSINESS NAME
ADDRESS %T . I _A 1 r4 C 14 , D
PHONE `71y - aa3 -stoou EMAIL Tt_mPfvVQg. c.D
CONTRACTOR'S STATE LIC NUMBER (og V 7 13 LICENSE CLASSIFICATION C
VALUATION $ 4y.S �' SO L SO FT
APPLICANT'S SIGNATURE ��-� DATE 1/ /od Ja-ol�
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BURRING PLANNING ENGINEERING FIRE GREEN l SMIP
INVOICE ID. J PAID AMOUNT
AMOUNT _t`b OCASH OCHECKM 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZED LETTER G YES 0 NO
City of Menif e Building&Sajety Deportment29714 HGun Rd. Menijee, C4 925S5 951-572-5777
www.cityofinenifee.us Inspection Request Line 951-246-5213
�.I► d
• - �,• ,, - , 11 .�
MAM
It
So
II -
�� -�`
. . . . . . . . . . . .
ur
Intl
MOOCOQRE
- cocoAw
o 19
oo
:. ��\
� N
ti .a
i
t I," \
� ��