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PMT16-00285 City of Menifee Permit No.: PMT16-00285 29714 HAUN RD. �J-�CCEL/� MENIFEE,CA 92586 Type: Commercial Electrical MENIFEE Date Issued: 02/17/2016 PERMIT Site Address: 24311 BUCKSTONE LN, MENIFEE, CA Parcel Number: 92584 Construction Cost: $1,300.00 Existing Use: Proposed Use: Description of CABLE POWER SUPPLY AND METER PEDESTAL Work: 100A Owner Contractor JOHN GRIFFIN CONSTRUCTION INC 244 JASON COURT CORONA,CA 92879 Applicant Phone:9512782377 FROSTY RUSSELL License Number.618983 JOHN GRIFFIN CONSTRUCTION INC 244 JASON COURT CORONA,CA 92879 Fee Description Qtv Amountl5) Services,Switchboards, Control Centers&Panels 1 183.00 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 $368.62 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 ENSED DECLARATION ❑ 1 am exempt from licensure under the Contractors'State License Law for the following reason: (Expires herebyhapterBy my signature below 1 acknowledge that, except for my personal residence in rofesswhich I must have resided for at least one year prior to completion of icense Class A-� L-'I G 1 D Lice se No. improvements covered by this permit,1 cannot legally sell a structure that I have ��311 Signature �.G r• built as an owner-building if it has not been constructed in its entirety by licensed contractors. 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 is submitted or at the following Web site: ❑ I hereby affirm under penalty of perjury one of the following declarations: htto://v .leginfo.m.gov/calaw.htmi. 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. 'I� Property Owner or Authorized Agent Policy# R W L �. �'2, Z e �x.�1' ❑ 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 owners behalf. I have read this 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 comply permit is issued.My workers'compensation insurance carder and policy number are: with all applicable city and county ordinances and slate laws relating to building construction.I authorize representatives of this city or county to enter the above. Carrier Ai AWr;� )AS LO identified property for the inspection purposes. Policy#P.W L C. Expires )h-�^ �6 Dale Property Owner orAuthorized Agent (This section need not be completed If the permit is for Lmatedal Business License# b35�+15one-hundred dollars($100)or less) ZARDOUS MATERIAL DECLARATION ❑ 1 certify that in the performance of the work for which this permit is Issued,I shall not emolov any persons in any manner so as to become subject to the the applicant or future building occupant handle hazardous material or a workers'compensation laws of Califomia, and agree that if I should becometure containing a hazardous material equal to or greater that the subject to the workers'compensation provisions of Section 3700 of the Laborounts specified on the Hazardous Materials Information Guide? ode,I shall forthwith comply with those provisions. ES 17 NOpplicant;3oh1 C&5tI 4o. ,Date; z'11^Z.CA6 the intended use of the building by the applicant or future building upant require a permit for the construction or modificotion from South WARNING: FAILURE TO SECURE WORKERS' st Air Quality Management District(SCAQMD)?See permitting checklist COMPENSATION COVERAGE IS UNLAWFUL, AND SHALLguidelinesSUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANDES M NOCIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, the proposed building or modified facility be within 1000 feet of the outer DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THEndary ofaschool7LABOR CODE, INTEREST,AND ATTORNEYS FEES ES Gf NOCONSTRUCTION LENDING AGENCY ve read the Hazardous Material Information Guide and the SCAQMD I hereby affirm that under the penalty of perjury there is a construction lendingmitting checklist.I understand my requirements under the State of agency for the performance of the work which this permit Is issued (Sectionifomia Health&Safety Code,Section 25505 a 25534 concerning 3097 Civil Code) ardous matedal reporting.OWNER BUILDER DECLARATIONS ES ❑NO n I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date z-j I^zy License Law for the reason(s)indicated below by the checkmark(s)I have placed V PROPERTY OWNER OR AUTHORIZED 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(RRPI 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 70D0)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 licensure and the basis for the alleged exemption. Any required practices.This includes rental properly 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 EPKs 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 Finn 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 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 SAFETYPERMIT/PLAN CHECK APPLICATION Menifee DATE PERMIT/PLAN CHECK NUMBER jkMU- d TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK ?owe.CCSuePL q M1e-TEZ% CitV of Manifn Building & Safety ept. PROJECTADDRESS �`� /,iclL'�i'STbNEzirl FEB 0 4 20 ASSESSOR'S PARCEL NUMBER LOT TRACT VU OWNERNAME j - ((.�� ADDRESS PHONE EMAIL APPLICANT NAME ADDRESS z44 -1AS0A C.7,- 7 PHONE 951.2'15--? 11] 1 EMAIL D/{ i — N LiE i &4kVkOQ.Z-0fA CONTRACTOR'S NAME J.F,M QjN OWNER BUILDER? OYES 0NO BUSINESS NAME ADDRESS PHONE EMAIL , CONTRACTOR'S STATE LIC NUMBER h I89 S 3 LICENSE CLASSIFICATION VALUATION$ SO FT SO FT APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT I I I I O CASH O CHECK# O CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building& Safety Deportment 29714 Houn Rd. Menifee, CA 92556 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-5213