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PMT15-03717 City of Menifee Permit No.: PMT15-03717 29714 HAUN RD. Type: Commercial Electrical <;kC,CELA— MENIFEE,CA 92586 MENIFEE Date Issued: 12/09/2015 PERMIT Site Address: 28877 NEWPORT RD, MENIFEE, CA Parcel Number: 364-030-004 92584 Construction Cost: $10,000.00 Existing Use: Proposed Use: Description of INSTALL TEMP POWER WITH 2O0A METER, 14 SPAN POLES,6 SERVICE POLES Work: Owner Contractor FOOTHILL ARCH LLC DIAMOND POWER SERVICES INC 29105 ARCHIBALD AVE 807 E MISSION ROAD ONTARIO, CA 91761 SAN MARCOS,CA 92069 Applicant Phone:7607447191 DALE ROLPH License Number:908341 DIAMOND POWER SERVICES INC 807 E MISSION ROAD SAN MARCOS, CA 92069 Phone:9518408625 Fee Description Dy Amount 151 Services,Switchboards,Control Centers&Panels 6 1,098.00 Building Permit Issuance 1 27.00 Additional Plan Review Building 74 74.18 GREEN FEE 1 1.00 General Plan Maintenance Fee-Electrical 1 54.90 $1,265.08 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_Bldg Permit_Template.ryt Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ lam exempt from licensors 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 WinW and By my signature below I acknowledge that, except for my personal residence in Professions Code and my license is in full force a ct. which I must have resided for at least one year prior to completion of License Class !�Llcens (J l improvements covered by this permit,I cannot legally sell a structure that I have Expires 1 �-' a 7— .7ddignature c.C/ built as an owner-building if it has not been constructed in its entirety by licensed -7 1contractors. I understand that a copy of the applicable law,Section 7044 of the WORKERS'COMPENSATION DECLA TION Business and Professions Code,is available upon request when this application is submitted or at the following Web site: ❑ 1 hereby afire under penalty of perjury one of the following declarations: httoJ/www.leainfo.ca.aovlcalaw.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 property XI have and will maintain workers' compensation insurance, as required by o er or authorized to act on the property owner's behalf. I have read this sec on 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 comply permit is issueed.My workers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to building / s construction.I authorize representatives of this city or county to enter the above- Carrier 4"n/rer�/�F/ � 5, pro / L� identified property for the inspection purposes. Policy#SWC 1676(fs/6 Expires 3 Date Property Owner orAuthorized Agent (This section need not be completed if the permit is for City Business License# 055y:�130, one-hundred dollars($100)or less) ❑ I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION shall no#compenlson ers s in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a workers I s f California,and agree that if I should become mixture containing a hazardous material equal to or greater that the subject ' ensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide? Code,I lywith those provisions. ❑YES ONO ApplicaDate; �Z / � Will the intended use of the building by the applicant or future building occupant require a permit for the consWction or modification from South WARNFAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist COMPCOVERAGE IS UNLAWFUL, AND SHALL for guidelines ' SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES 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 of a school? LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES fZLNO 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 y requirements under the State of agency for the performance of the work which this permit is issued (Section California Health 8 Saf Co tion 25505 and 25534 concerning 3097 Civil Code) hazardous material ortin . OWNER BUILDER DECLARATIONS DYES �NO 1 hereby affirm under penalty of perjury that I am exempt from the Contractor's Date 12 y License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPER E O OR THORIZED AGENT next to the applicable Item(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 firths and comply with she is exempt from ]!censure 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.epe.gov/lead or contact the National Lead Information Center at ❑ 1, as owner of the properly, or my employees with wages as their sole 1-800.424-LEAD(5323). compensation,will do( )ail 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 Stale 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 0 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 PERMIT/PLANBUILDING & SAFETY APPLICATION "'Menifee DATE G-/ 2vI-S PERMIT/PLAN CHECK NUMBER TYPE: MMERCIAL O RESIDENTIAL C MULTI-FAMILY C MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION C ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK 11ce /—lf le f PROJECTADDRESS lvf oL/el s � t��P�!'/N ASSESSOR'S PARCEL NUMBER ,��✓%7U�'-Gbq• LOTTRACI' it e �/` / .. Dem. OWNER NAME Al e /4 Q 15 ADDRESS G d/(/�� PHONE �Qc✓-,S�/ J�C'l7�/' EMAIL Received APPLICANT NAME /—�„I /,(� L ADDRESS & 7G- I�`•.S S% !�` C° ��.c(�i l�/lG�✓f!�S /(/� / PHONE ��/ 09��✓�LJ^ EMAIL C.//G�HdU6v'(�I�IJ�<�®t''I. CONTRACTOR'S NAME / U✓(�Cf / fQ e6)N,S?4 4 1 NER BUILDER? O YES ANO BUSINESS NAME 0Gx!/LLy JIJ�C(�/��✓C(/L/, �� /� ADDRESS 7 PHONE Lf�Yl/'SSiCJ�/EMAIL � VC., J � Cd%' /G!✓-� CONTRACTOR' STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION .� L SO FT SQ APPLICANT'S SIGNATURE F&—YSTAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT O CASH O CHECK q O CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT OCASH OCHECKA OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER 0 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