PMT15-03619 City of Menifee Permit No.: PMT15-03619
29714 HAUN RD. Type: Commercial Electrical
�/-�CCEL/-> MENIFEE, CA 92586
MENIFEE Date Issued:
11/2312015
PERMIT
Site Address: 28758 ARGO ST, MENIFEE, CA 92584 Parcel Number:
Construction Cost: $500.00
Existing Use: Proposed Use:
Description of 2-200AMP TEMP POWER POLES FOR TR 28859-2 OAKHILLS
Work: 28758/28670 Argo St.
Owner Contractor
RIDGEMORE INVESTMENT, LLC
26040 ACERO
MISSION VIEJO, CA 92691
Applicant License Number:
MOHAMMAD KASHANI
RIDGEMORE INVESTMENT, LLC
CA
Fee Description ON Amount IEI
Services,Switchboards, Control Centers&Panels 2 232.00
Building Permit Issuance 1 27.00
Additional Plan Review Building 148 148.37
GREEN FEE 1 1.00
General Plan Maintenance Fee-Electrical 1 11.60
$419.97
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.
AA_Bidg_Permil Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from Iicensure under the Contractors'State License Law for the
I hereby affirm under penalty or perjury that I am licensed under provisions of following 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 in
Professions Code and license is in full force and effect. which I must have resided for at least one year prior to completion of
License Class License No. improvements covered by this permit, I cannot legally sell a structure that I have
Expires Signature built as an owner-building if it has not been constructed In its entirety by licensed
contractors. I understand that a cop of the applicable law,Section 7044 of the
WORKERS'COMPENSATION DE r Business and Professions Code,is ailable upon request when this application is
submitted or at the following We rite:
Vfe�khereby affirm under penalty of perjury one of the fallowing declarations: litto, tml.
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
Section 3700 of the Labor Code, for the performance of work for which this Date
permit is issued. wn rorAuthodzedAgenl
Policy# :5'L( ❑ By my Signature below, I certify to each of the following: I am the property
❑ 1 have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read this
section 3700 of the Labor Code, for the performance of the work for which this application and the information have provided is correct. I agree to comply
peril is issued.My workers'compensation insurance carder and policy number are: with all applicable city afieCtiDn
ordinances and state laws relating to building
1 I construction.I authorizeatives of this city or county to enter the above-
Carrier 5�R7"P g.cin d identified p p " or th purposes.
�r—r ' Z �� 8— (Poicy#� f J (( xp Date
Pr a ero uthorized
Agent
(This section need not be completed if the permit is for City Business License#
one-hundred dollars($100)or less)
certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ any persons in ny manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers'compensation laws of altfomia, and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compayfiation provisions of Section 3700 of the Labor amounts s ecM don the Hazardous Materials Information Guide?
Code,I shall forthwith c ply ith those provisions. ❑YES
j0
Applicant; Date;_1 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: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelin s
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND ❑YESO NO
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 of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES El YES�JO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Info aban Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my re uirements under the State of
agency for the performance of the work which this permit is issued(Section California Health&Safety Code,Secti n 25505 and 25534 concerning
3097 Civil Code) h_a`Zardous material 7reprtin
OWNER BUILDER DECLARATIONS l>,wtrES �NO
I hereby affirm under penalty of perjury that I am exempt from the Contractor's ``''�� Date
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPER - OWNER OR AUTHORIZED AGENT
next to the applicable Rem(s)(Section 7031.5.Business and Professions Code:
Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION,REPAIR AND PAINTING(RRP)
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:
www.epa.gov/lead or contact the National Lead Information Center at
❑ I, as owner of the property, 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).
❑ 1, as owner of the property an exclusively contracting with licensed O No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors 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
s ® i / s s •L110-ATION
jin R, Safely DOPI-
= MenlTee
w,��Inina
DATE ()v 1 e 2015 PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL;, W RESIDENTIAL O MULTI-FAMILY 0 MOBILE HOME O POOL/SPA 0 SIGN
a t�y-
SUBTYPEr°O ADDITION O ALTERATION O DEMOLITION 0 ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK _ �Li✓U TC'M �UY✓'� '(mac,( -�
PROJECTADDRESS �L8 ,�7 GOCv 7C
ASSESSOR'S PARCEL NUMBER LOT TRACT
PROPERTY OWNER'S NAME U L
ADDRESS (, C7 y) (/ I a 9)
PHONE �(`C` jo C4 /C 2 EMAIL /
APPLICANT NAME , I
ADDRESS a v /6412S4 4 j/1C7\ CA -( `-t-= l
PHONE (G1(�Gj �(�_ t (/ J EMAIL b r�
CONTRACTOR'S NAME / r G =+ OWNER BUILDER? !AYES ONO
BUSINESS NAME , / C
ADDRESS
PHONE ICIe7_ /(j^u( 'J 2 EMAIL
CONTRACTOR'S STATE LIC NUMBER 00 LICENSE CLASSIFICATION
VALUATION$ SO L SO FT
APPLICANT'S SIGNATURE DAT
a
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT I 1 0CASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK H 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O 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