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PMT16-02619 City of Menifee Permit No.: PMT16-02619 29714 HAUN RD. �ICCEL./-> MENIFEE, CA 92586 Type: Commercial Electrical MENIFEE Date Issued: 0811112016 PERMIT Site Address: 28877 NEWPORT RD, MENIFEE, CA Parcel Number: 364-030-004 92584 Construction Cost: $1,100.00 Existing Use: Proposed Use: Description of RELOCATE EXISTING TEMP POWER POLE AND 200A U/G METER WITH 1201240V POWER PANEL Work: Owner Contractor FOOTHILL ARCH, LLC DIAMOND POWER SERVICES INC 2910 S ARCHIBALD AVE,#A-350 807 EMISSION ROAD ONTARIO, CA 91760 SAN MARCOS,CA 92069 Applicant Phone:7607447191 DALE ROLPH -License Number: 908341 DIAMOND POWER SERVICES INC 807 E MISSION ROAD SAN MARCOS, CA 92069 Fee Description ON Amount($1 Services,Switchboards,Control Centers&Panels 1 183.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Electrical 1 9.15 $220.15 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 staled,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 ❑1 am exempt from Iicensure underthe Contractor's State License Law for Professions Code and my license is in full force a d effect. the following reason: License Class y Lic e N g3 y By my signature below I acknowledge that,except for my personal residence Expires'/Z-P7 Signature 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 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 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 wwvv.Ieginfo.ca.gov/calaw.htmI.permit is Issued. w Policy# Date ❑I have and will maintain workers 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 an the property owners behalf.I have read this number are: application and the Information I have provided is correct.I agree to comply Carrier�eL-TG'✓/V GH .sG�o'w'�+ /�✓O� with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy#,sGvC!/6ZL 7!€xpires 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 o l certify that in the performance of the work for which this permit is issued, I shall not em010v an persons in any manner so as to become subject to the CITY BUSINESS LICENSE# workers compens on laws California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to thew ers co ens n provisions of Section 3700 of the Labor Code,IshalIf withc ply those provisions. ( 9 Will the applicant or future building occupant handle hazardous material or Applicant Date �� mixture containing a hazardous material equal to orgreater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO S URE WORKER'S COMPENSATION COVERAGE IS 0 Yes &&NO UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,00D),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 SECr10N 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY o Yes o No 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 lending agency for the performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) ❑Yes 0 No 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 perjurythat 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 nextto the applicable item(s)(Section 7031.5 oYes ❑No Business and Professions Code).Any city or county that requires a permit to Date construct,alter,improve,demolish or repair any structure,priorto its PROPERTY OWNER 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(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 Cade)or that he or she is exempt from Iicensure 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 ❑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( i portion of the work,and the structure is www.eoa.aov/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. 0 No EPA Lead-Safe Certified Firm Is required for this project because: o I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contactors 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. 1,J&,,k Men ifee DATE PERMIT/PLAN CHECK NUMBER - Oa Lem TYPE: COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION �EcTRICAL O MECHANICAL ONEW O/PLUMBING ORE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK ,ZUG /4l/y CA, Llar<`? 7 Zo z Yw -/ G f,7� «< PROJECFADDRESS 99/ CG✓ O,-/- /C r L�<< C Oi eDept. ASSESSOR'S PARCEL NUMBER U — 194 TRACT OWNER NAME f�f�� Arc C 016 ADDRESS G �{�GIC <, 11w �u�/'^ PHONE EMAIL APPLICANT NAME /« // ADDRESS Q /77Jjf1dN 2Cl PHONE _ys�� —�Uo�J EMAIL l.�C.�[C✓ <J/G'✓1lA�iC+ /'Ol/slS•('�+!i--i CONTRACTOR'S NAME l J G, e,,r(7 G✓eY Se, %-6WNER BUILDER? O YES NO BUSINESS NAME (L(_/l�/»<J/«`, ��v� C/ice✓/t.�''�S,/ ADDRESS r PHONE JJ(/' EMAIL C.E�i<C✓ �f(GIJJO�vnI ` �r:�� CONTRACTOR'S STATE LIC NUMBER/ LICENSE CLASSIFICATION el 0 VALUATION$ 11O0- of-) SO FT L SO FT APPLICANT'S SIGNATURE DATE CITY STAFF USE ONL Y DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP X INVOICE ^ PAIDAMOUNT AMOUNT aO- IC OCASH 0CHECK# 0CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofmenifee.us Inspection Request Line 951-246-6213 C e � v ti -n m 7-7 rb vv c � c7 po o CD w m Z G ^' m CD rn c m f Ca 9 RA'�'�W FICE COPY