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PMT16-00307 City of Menifee Permit No.: PMT16-00307 29714 Type: Commercial Electrical SnCCEL/� MENIFEE,EE, C CA 92 92586 MENIFEE Date Issued: 0 810 3/2 01 6 PERMIT Site Address: 28947 HWY 74, MENIFEE, CA 92585 Parcel Number: Construction Cost: $2,000.00 Existing Use: Proposed Use: Description of 100A METER SINGLE PEDESTAL Work: 2-METERS TC1 /LS-3 City of Menifee Project no fees Owner Contractor CITY OF MENIFEE HAL HAYS CONSTRUCTION INC 29714 HAUN RD 4181 LATHAM STREET MENIFEE, CA 92586 RIVERSIDE, CA 92501 Applicant Phone:9517880703 MENIFEE, CA License Number:667560 Fee Description ,Q�rt Amount(S) 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.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License Law for Professions Code and my license is in full force and effect. / the following reason: License Class C License No. � 2-s-L-D By my signature below I acknowledge that,except for my personal residence Expires �l �3a�2o(� Signatures !•X in which l must have resided for at least one year prior to completion of Improvements covered by this permit.I cannot legally sell a structure that 1 WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by o I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Code,is available upon request when compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website: by Section 3700 of the Labor Code,for the performance of work for which www.Ieginfio.m.Rov/calaw.htm1.permit is issued. Policy q Date ZI have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which o By my signature below I certify to each of the following:I am the property this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this number are: (� l I�_ application and the information I have provided is correct.I agree to comply Carrier CIAIIYUI1_11(_ lmucfrflf,l. WrIVLQar with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy9 Z7.K I?A-01-b3 Expires II 1, 4, enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT /� ❑I certify that in the performance of the work for which this permit is issued, O�$��`'' I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE p workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 3700 of the Labor Code,I shall fort7 comply �wit/Iythose provisions. Will the applicant or future building occupant handle hazardous material or Applicant", r (/ Date S1� mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes AN. UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use ofthe building by the applicant or future building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines - CONSTRUCTION LENDING AGENCY o Yes "a I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the tending agency for the performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) o Yes o No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD 1 hereby affirm under penalty of perjury that 1 am exempt from the permitting checklist.I understand my requirements under the State of California Health&Safety Code,Section 25505 and 25534 concerning Contractors License Law for the reason(s)indicated below by the hazardous material reporting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Otifes o No Business and Professions Code).Any city or county that requires a permit to �/ Date A SSG construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR A&FIORIZED AGENT Issuance,also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRPI License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978 and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property than($500). managers who do the paint-disturbing work themselves orthrough their o I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit: compensation,will do( )all of or( )portion of the work,and the structure is www.epa.eay/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323). Code;The Contractors State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project property who,through employees'or personal effort,builds or improves the property provided that the improvements are not intended or offered for Certified Firm Name: sale.If,however,the building or improvement is sold within one year of Firm Certification No.: completion,the Owner-Builder will have the burden of proving that it was not built or improved for the purpose of sale. O No EPA Lead-Safe Certified Firm is required for this project because: ❑I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement 5 CONSTRUCTION INC. License#667560 August 4, 2016 Attention: CITY OF MENIFEE 29714 HAUN ROAD MENIFEE,CA 92586 Reference: Letter of Authorization To Whom it may Concern, The intent of this letter is to formally authorize Ivan Vega to pull the permits # PMT 1600307 & PMT 1600308 on behalf of Hal Hays Construction, Inc. (the Contractor). Thank you. Sincerely, Kirb Hays President/CEO Hal Hays Construction,Inc. 4181 Latham Street,Riverside,CA 92501 (951)788-0703 Phone (951)788-1517 Fax ♦ www.halhays.com BUILDING &SAFETY PERMITIPLAN CHECK APPLICATION �aY Menifee DATE PERMIT/PLAN CHECK NUMBER ,4T�p.,7o7-07 3c8 TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION �dELECFRICAL O MECHANICAL O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK IL�Hh lNh L � i PROJECTADDRESS ASSESSOR'S PARCEL NUMBER LOT TRACT OWNER NAME ADDRESS PHONE EMAIL APPLICANT NAME V ADDRESS PHONE Ila)- 4�7 EMAIL 'D iy . ,•F(i(�`/� e 11dM CONTRACTOR'S NAME /aL 41A-I -5 ( OWNER BUILDER? O YES O NO BUSINESS NAME ADDRESS rL/✓L1ZSJ I)L% SOI PHONE 67) 3 EMAIL (Zt-:: VAa L CONTRACTOR'S STATE LIC NUMBER 624o7�60 LICENSE CLASSIFICATION GZ�. VALUATION$ `7 A�n &I SQ FT L SO FT o� -v APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT OCASH OCHECKR OCREDITCARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH OCHECKR OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Deportment 29714 Noun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213