PMT16-01676 City of Menifee Permit No.. PMT16-01676
29714 HAUN RD.
�/-ACCELX— MENIFEE, CA 92586 Type: Sign-Permanent
MENIFEE Date Issued: 06/01/2016
PERMIT
Site Address: 30050 HAUN RD, MENIFEE, CA 92586 Parcel Number: 360-690-027
Construction Cost: $3,000.00
Existing Use: Proposed Use:
Description of INSTALLATION OF 2 EXTERNAL CHANNEL LETTER ILLUMINATED WALL SIGNS FOR"FOREVER
Work: 21"
Owner Contractor
DONAHUE SCHRIBER REALTY GRP CENTERLINE SIGNS
30050 HAUN RD 10833 CHERRY STREET
COSTA MESA, CA 92626 LOS ALAMITOS, CA 90720
Applicant Phone: 5626183707
JAMES KAKALLIS License Number: 1013962
CENTERLINE SIGNS
10833 CHERRY STREET
LOS ALAMITOS, CA 90720
Fee Description ON Amount t51
Sign Permit 2 190.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 9.50
$227.50
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
with a licensed contmctor(s)pursuant to the Contractors State License Law).
1 hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and D I am exempt from licensure under the Contractors State License Law for
Professions Code and my license Is in full force and effect. the following reason:
License Class 4L,—L/` Li c a No. /0/ 39 o6 By my signature below I acknowledge that,except for my personal residence
Expires 3 3)• daj is Signature C in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLA ION have built as an owner-builder if it has not been constructed in its entirety by
❑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 workers 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,lesinfo.ca.eov/calaw.html.
this permit is issued.
Date
Policy 8
PROPERTY OWNER OR AUTHORIZED AGENT
o I have and will maintain workers compensation Insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which ❑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: application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
Policy It Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
\d^ollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
�Fcertify that in the performance of the work for which this permit is issued,
// I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE It
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 forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant 6 �C ! Date a 6'61-%4 amounts Ss,p�e•cified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 6 D Yes WVo
UNLAWFUL,AND SHALLSUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applimnt 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)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY a Yes �/fJ0
I hereby affirm that under the penalty of perjury there is a construction Will the/p�roposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) D Yes
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the 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 oyes
Business and Professions Code).Any city or county that requires a permit to Date 06 •61-
construct,alter,improve,demolish or repair any structure,prior to its PROPERTXbWNER OR AUTHORIZED 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(RRP)
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 or through 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.gov/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 Contrectors State License Law does not apply to an owner of a D 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
❑No EPA Lead-Safe Certified Firm is required for this project because:
not built or improved for the purpose of sale.
D 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.
& SAFETY PERMIT/PLAN CHECK APPLICATION t=
ir"Menifee
DATE PERMIT/PLAN CHECK NUMBERDnita- c (Q
TYPE: COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA IGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Ti,.,11S LLiq or 2 36" SETS OF mrwiu-
�LC L7 S" � �b 2V%P� Z I ltrS LG L C
PROJECT ADDRESS 66 — /-14UN 1120
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME IJi= E
ADDRESS e-E2
PHON61 !-' - c(pa EMAIL ✓ �� aWL
APPLICANTNAME
ADDRESS CU 13 �GE�Ef2R
PHONE(5-6-- ljr/D _ 3` 0'T EMAIL .Icy t'Y�LEN��CD'"r`-S7�/I%Sp/l;p T ,cagy
CONTRACTOR'S NAME OWNER BUILDER? O YES O NO
BUSINESSNAME
ADDRESS Q 3 G . ! O ll, 07ZO
PHONE r-6Z ^ 3707 EMAIL
CONTRACTOR'S STATE LIC NUMBER /D/ 3 96 Z LICENSE CLASSIFICATION
VALUATION$ O[:O /S'Q FT L SO FT
APPLICANT'S SIGNATURE DATE 426-61-/C
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN I SMIP
INVOICE /1��CA\ PAIDAMOUNT
AMOUNT a IJ�J O CA5H O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92585 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
STATE OF CAUFORNIA
CERTIFICATE OF COMPLIANCE, SIGN LIGHTING City of Menlfse Ei
CECSLTG-1C(Revised 10110) UII ding & SafetY'ADRI�INIA ENERGY COMMISSION
Certificate of Compliance (Sign Lighting) JUN 0 1 201 S (Page 1 of4) SLTGIC
Pro'ectName: Date:
o C_ P-
Z(
Project Address:
3co to 20,
Location of Sign Outdoor Signs ❑ Indoor Signs
Phase of Sign Construction fiMew Signs ❑ Sign Alterations
Typeof Li tin Control ❑ New Lighting Controls ❑ Replaced Lighting Controls ❑Not Installing Lighting Controls
This Certificate of Compliance includes the following components(check all that apply)
❑ Mandatory Measures(Lighting Controls) ❑ Maximum Allowed Lighting Power ❑ Specific Lighting Sources
1. Certificate of Compliance Declaration Statement(this may be a CIO,C45 or other eligible person)
I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and
correct.
I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the lighting design.
This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with
Title 24,Parts 1 and 6 of the California Code of Regulations.
• The design features represented on this Certificate of Compliance are consistent with the information provided to document
this design on the other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the
enforcement agency for approval with this building permit application.
Named Signature
J Ft titES lCrt(�t.LL=S '
Compatry: - Ph o e
r.> ,- o tK /v �G Z 64- 370
Add: License number(may be contractor's He#)
10833 CA4 SIC / 3
Citylstatelzip/1: Date ,y
O P LA nnT 07Z0 OY'O!•%L
2. Installation Certificate(to be signed by responsible person after installation)
Permit number Chccked by/Dme
(Wmoemmt Agmry Use) (Enfaaemeat Aged Use
Installation Declaration statement
I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and
correct.. r
I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized A
representative of the person responsible for construction. y
I certify that the installed features,materials,components,or manufactured devices identified on this certificate conforms to all
applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the
enforcement agency.
I certify that the requirements detailed on this Certificate of Compliance have been met. `
I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building
permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. I understand
that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the mesa
building owner at occupancy.
Company Name:
CY�jE. N CW-
Res nsible Person's Name: -ble Persm's Si t11[e:
7Ms S KAVALLCwr`r
License number(may be contractor's He#) Date Signed: P tion With Co"pony:
101 ,3q6z 06,
2008 Nonresidential Compliance Forms October 2010
STATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE, SIGN LIGHTING E
CECSLTG-1C(Revised 10110) CALIFORNIA ENERGY COMMISSION
Certificate of Com fiance(Sign Lighting) (Page 2 of 4 SLTG-IC
Project Name: e
3. Mandatory Sign Lighting Controls
NOTES:
1. The same responsible person may install both the sign lighting power and the sign lighting controls, or a different responsible
person may install the sign lighting controls than the responsible person installing the sign lightingpower.
2. The Mandatory Measures(sign lighting controls)are requiredfor compliance with the sign lighting Standards. If the person
responsible for installing the sign lighting power is not also responsible for the sign lighting controls, then the owner of the
sign,general contractor, or architect shall be responsible to have the sign lighting controls installed
3. If more than one person has responsibility for compliance, each responsible person shall prepare and sign a Certificate of
Compliance and an Installation Certificate applicable to the portion of construction for which they are responsible,
alternatively, the person with chief responsibility for construction shall prepare and sign the Certificate of Compliance
Declaration Statement k the entire construction
3a. Statements of Responsibility: Any person signing the Certificate of Compliance Declaration Statement on page 1 of
4 on this SLTG-1 C shall complete Part 3a_Check Yes or No for all of the following statements:
1 I have responsibility for installing the sign lighting controls
❑ Yes,complete arts 3a and 3b of this form No,complete part 3a of this form
2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls
❑ Yes o
3 There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls
yes ❑ No
/There are existing sign lighting controls that do not comply with the applicable provision of§t 19 and§133 and 1 will be
4 installing compliant sign lighting controls
❑ Yes No
FT:hereare existing sign lighting controlsthat donotcomply withthe applicable provision of§119 and§133 and someone else
5e responsible to install compliant sign lighting controls
s No
3b.Mandatory Sign Lighting Controls
If the person signing the Certificate of Compliance Declaration Statement on page I of 4 of this SLTG-I C is responsible for
complying with the sign lighting control re uiremeins,that person shall answer all of the following questions:
If there are construction documents,indicate where on the building plans the
mandatory measures(sign lighting control note block can be located:
1 §133(a)1.All indoor sign lighting is controlled with an automatic time switch control that complies with the Y N NA
applicable requirements of§119. ❑ ❑
§133(a)l and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photo Y N NA
2 control,or an outdoor astronomical time switch,that comply with the applicable re uirements of 119. ❑ ❑
Exception to§133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during Y N
daylight hours. ❑
§133(a)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce Y N NA
signpower b a minimum of 65 t duringnighttime hours. ❑ ❑
Exception 1 to 133 a Si illuminated for less than one hour per d during daylight hours. 11 NA
p § ( }l.Signs� P day g ❑
3 Exception 2 to§133(a)3. Outdoor signs in tunnels or large covered areas that require illumination during Y NA
daylight hours. ❑
Exception 3 to§133(a)3.Only metal halide,high pressure sodium,cold cathode,or neon lamps used for Y NA
illuminating signs or parts of signs.
❑
§133(a)4. An Electronic Message Center(EMC)having a new connected lighting power load greater than Y N N/A
15 kW has a control installed capable of reducing the lighting power by a minimum of 30 percent when ❑ ❑ M
4 -receiving a demand response signal that is sent out by the local utility. P
Exception to§133(a)4.EMC required by a health or life safety statue,ordinance,or regulation,including Y NA
but not limited to exit signs and traffic signs. ❑
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010
STATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE, SIGN LIGHTING � 1
CECSLTGIC(Revised 10110) CALIFORNIA ENERGY COMMISSION
Certificate of Compliance(Sign Lighting) (Page 3 of 4 SLTG-1C
Project Name: Date:
4.Maximum Allowed Li¢htinz Power Method of Compliance
Certificate of Compliance and Field Inspection Energy Checklist
Complete this part if there are signs using the maximum allowed lighting power method of compliance.(Complete part 5
of this Certificate of Compliance if there are signs using the S ecific liahtinIZ sources method of ornpilianee
A B C D E I F G H I J
Allowed Watts Design Complies?
E9 Watts Y/N
o o Field
v y y 0 Inspector
..
U a o ° w-o C�� m VI Check that
Sign
Ei
e m
�° c E 3 N d C .2 •60 ; Complies
T z $ d a o I-on .t. 11 o
o
F
Description ❑o; /
ITQ SNSSMI�RTSot.t �I ❑ 55 SD ^� Z G 364 ❑SET oF• rer�A E L=T
k AROArLA ORES VVE1e 2 ❑
L�
41''rtJ =5 36"r< 2y'v'iZ ❑
❑ ❑
❑ ❑
A I Symbol or code used on the plans(when plans arerequired)and other documents.
B A narrative description of the sign,or location of sign on the building;and the location of sign on construction documents.
OPTIONAL-Check this box only if this sign has a permanent,pre-printed,factory-installed,ENERGY VERIFIED label,confirming that
the sign complies with the Section 148 of the California 2008 Title 24,Part 6 Standards,using the Maximum Allowed Lighting Power
method of compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized
C by Underwriters Laboratories(UL)or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National
Standards Institute in accordance with ISO/IEC 17011.Surveillance by the Accredited Certification Body shall be an ongoing annual
inspection program carried out by a Type A Inspection body in accordance with ISO/IEC 17020.For signs with such an ENERGY
VERIFIED label,columns`D'through`I'are not required to be filled out Note:Using an ENERGY VERIFIED label is an optional
method to validate compliance.An ENERGY VERIFIED label is not needed for compliance.
D The sign area in square feet
E List'I"if the sign is internally,illuminated. List"E"if the sign is externally illuminated
F Allowed watts per square foot Enter 12 if the sign is listed as"I"in column E.Enter 23 if si is listed as"E"in column E.
C Multiply the square footage in column D times the allowed Lighting Power Density PD=watts)in column F.
H Show the total installed watts in the sign,as determined according to the applicable provisions of$130(d ore).
I Enter Y if the number in column H is less than or equal to the number in column G. Otherwise,the sign does not comply.
J This page doubles as a field inspection checklisL
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010
STATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE, SIGN LIGHTING
CECSLTGIC(ReNsed 10110) CALIFORNIA ENERGY COMMISSION
Certificate of Compliance (Sign Lighting) (Page 4 of 4 SLTG-IC
Project Name: Date:
EVE e Z
5. Specific Li¢htine Source Method of Compliance
Certificate of Compliance and Field Inspection Energy Checklist
Complete this part ifthere are signs using the Specific lighting source method of compliance. (Complete part 4 of this
Certificate of Compliance if there are simis using the maximum allowed lighting ower method of compliance)
A B C D E
OPTIONAL Field
ENERGY Specific light source used for Inspector
Symbol VERIFIED compliance Check that
or Description label Shall include only lighting Sign
Code (see instructions technologies listed below Complies
be
0 List all that apply
Tv5TALLt4T20fJ a'F I s'ET OF -7 LED LT-t-
36P Zr.Te-F &\'may ZLL' kwi a A-te0 L ❑ ❑
T C AP 'rre LET S
S l n ACc:7 IZEAVS-� "FOi'EJt�2 Zl ❑ F1
W' 'T(_I- LOGO Boll
it tt ❑ ? LEI) LTT-
Al
A I Symbol or code used on the plans when plans ate re and other documents.
B A narrative description of the sign,or location of sign on the building;and the location of sign on construction documents
C OPTIONAL-Check this box only if this sign has a permanent,pre-printed,factory-installed ENERGY VERIFIED label,confirming that
this sign complies with the Section 148 of the California 2008 Title 24,Part 6 Standards,using the Specific Lighting Source Method of
Compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by
Underwriters Laboratories(UL)or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National Standards
Institute in accordance with ISO/IEC 17011.Surveillance by the Accredited Certification Body shall be an ongoing annual inspection
program carried out by a Type A Inspection body in accordance with ISO/IEC 17020.For signs with such an ENERGY VERIFIED label,
column`D'is not required to be filled out Note:Using an ENERGY VERIFIED label is an optional method to validate compliance.An
ENERGY VERIFIED label is not needed for compliance.
Specific Light Source Compliance Method. The sign(s)identified above use only the following lighting technologies:
List all applicable numbers 1 ugh 10 that apply in column D above for each row.
I Iligh pressure sodium lamps
2 Pulse start or ceramic metal halide lamps served by a ballast with >88%efficiency
3 Pulse start metal halide lamps that are<_320 watts,are not 250 watt or 175 watt lamps,and are served by a ballast
with>80%efficient
4 Neon or cold cathode lamps with transformer or power supply effic ency>_ 75%with rated output current<50 mA
5 Neon or cold cathode lamps with transformer or power supply efficient >68%with rated output current>50 mA
D Fluorescent lamps with a minimum color rendering index(CRI)of 80
6 (Note:when using electronic ballasts for compliance,lamps with a CRI<80 may be used
7 LiRht emitting diodes (LEDs)with a power supply with>_ 80%efficiency
Single voltage LED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC
8 output,having a nameplate output power less than or equal to 250 watts,and certified to the Energy Commission as
complying with the applicable requirements of the Appliance Efficiency Regulations(Title 20
9 Compact fluorescent lamps that do not contain a medium screw base sockets E24/E26
10 Electronic ballasts with a fundamental output frequency>_20 kHz
E This page doubles as a field inspection checklist.
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010
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