PMT16-01246 City of Menifee Permit No.: PMT16-01246
29714 HAUN RD. Type: Commercial Electrical
<ACCELI MENIFEE,CA 92586
'PIA""' MENIFEE Date Issued: 04/27/2016
PERMIT
Site Address: 28763 ARGO DR, MENIFEE, CA 92584 Parcel Number:
Construction Cost: $150.00
Existing Use: Proposed Use:
Description of 200 AMP TEMP POWER POLE
Work:
Owner Contractor
JCA ENTERPRISE REAL ESTATE J C A ENTERPRISE REAL ESTATE INC
26040 ACERO 26040 ACERO
MISSION VIEJO, CA 92691 MISSION VIEJO,CA 92691
Applicant Phone:9496141434
MOHAMMAD KASHANI License Number. 1007980
J CA ENTERPRISE REAL ESTATE INC
26040 ACERO
MISSION VIEJO, CA 92691
Fee Description OQt Amount(E1
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
$368.52
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 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_Pemiit Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from licensure 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 (_6 / /i Signature44 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 Business and Professions Code,is /ailable upon request when this application is
submitted or at the following We i e:
I have re d affirm under penalty of perjury one t the following declarations: htt J/wwwle info.ca. ov/ca w.ttml.
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. n r or Authorized Agent
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
permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city and cou ordinances and state laws relating to building
/I canstrudtion.1 authorize repr entatives of this city or county to enterthe above-
Carrier Y3P �fJVI d identified p p ' or the i action purposes. �1
Policy#'�—/�--I — Date
pe ero uthoflzed
Agent
(This section need not be completed if the permit is for City Business License#
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 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 alifomia, and agree that If I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compeggation provisions of Section 3700 of the Labor amounts s ecified on the Hazardous Materials Information Guide?
Code,I shall forthwith ply, ith those provisions. DYES (i NO
Applicant; Date; !^ �� (7 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 ❑YESGNO
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 AD
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Info afi n Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my re irements 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 Cade) h j ardous material rep rting>
OWNER BUILDER DECLARATIONS I'O'yES �NO I^ ' (jam
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 PROPERT4 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(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.govAead or contact the National Lead Information Center at
❑ 1, 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).
❑ I, as owner of the property an exclusively contracting with licensed 11 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
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
� ."Menifee
DATE G(r Z o - PERMIT/PLAN CHECK NUMBER -Om
TYPE: 0 COMMERCIAL IVRESIDENTIAL 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 /l� O tiA/G a l
PROIECTADDRESS
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME /7 -c�
_ I
le
ADDRESS 744 L- c- 1 Co
PHONE b ,-� j c(2 2 EMAIL _ Cn
APPLICANT NAME 4 p
ADDRESS .,
PHONE y (I1 EMAIL /mLj42 tin
CONTRACTOR'S NAME OWNER BUILDER? BYES O NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ t 6C) S L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE I PAID AMOUNT AMOUNT I I 1 0CASH Y,CHECK# -CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES O NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
14
City of Menifee _
;:zilding & Safety Dept. \ City Of Menu
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APR 2 0 2016 i
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Fieceived �-� ► °�
3 C PUN 2
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:I PLAN I
CITY OF MENIFEE
BUILDING AND FETY DE TMENT/
PLAN APPROV LPLAN 2
REVIEWED Y -- - AF 20
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*Approval of these plans shall not be construed to be a per0it for,or an
approval of,any viblafioe of any provisions of the federa state or city /
regulations and ordinanc5.lhis set of approved plan ust be kept gn the /
jobsite until completion. \ /