PMT16-02774 City of Menifee Permit No. PMT16-02774
29714 HAUN RD. Type: Commercial Electrical
'c��- CCIEIILA—> MENIFEE, CA 92586
MENIFEE Date Issued: 1010312016
P E R M I T
Site Address: 31300 HAUN RD, MENIFEE, CA 92584 Parcel Number: 360-23D-017
Construction Cost: $15,000.00
Existing Use: Proposed Use:
Description of INSTALLATION OF 1)NEW 24"MICROWAVE DISH, 1)ODU BEHIND THE DISH&1)1/2'LINE TO
Work: EXISTING TOWER,T-MOBILE SITE IE95146A
Owner Contractor
MARY J CAREY TOTAL TELCO SPECIALISTS INC
4304 BENHURSTAVE 602 W SOUTHERN AVENUE
SAN DIEGO, CA 92122 ORANGE, CA 92865
Applicant Phone: 7144848266
,CA License Number: 720587
Phone: 9493361550
Fee Description 211K Amount I$)
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
Additional Plan Review Electrical 158 157.50
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 6.45
$321.02
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 prevenling 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).
ChapterEl(commencing with section 7000)of Division 3 of the Business and a I am exempt from licensure under the Contractoes State License Law for
Professions Code Md my license Is In full force and effect the following reason:
License Clam C_? U se PS, -7 By my signature below I acknowledge that,except for my personal residence
Expires 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
WS COM nECLAIRATIONV 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 workees 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this a pplication Is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which www.leglnfo.ca.gom&Plaw.html.
this permit is issued.
Policy If Date
x_lrl_ PROPERTY OWNER OR AUTHORIZED AGENT
Al nave and will maintain workees compensation insurance,as required by
s ction 3700 of the Labor Code,forthe performance of the work for which ci By mysignature below I certify to each of the following:I am the property
this permit is issued.My workees compensation insurance carrier and policy owner or authorized to act on the property owner's 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 oka gscv�)k_(716 eiLev4d I(A r- . Cof 10 building construction.I authorize representatives of this city or county to
Policy#&I J'�:VS Expires 31 13 1/ 1-7 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($10D)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
Ishallnotemplo any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and-agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall orthw Sth co Pry Mith ose provi.sions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified an the Hazardous Materials Information Guide?
WARNING:FAILUREGO SECURE W*KER'S COMPENSATION C�VERArp IS ci Yes 1111.
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($100,000),IN occupant require a permit for the construction or modification from South
AbDrrION 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 forguldefines
CONSTRUCTION LENDING AGENCY 0yes r".
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) 0 Yes YO
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and theSCAQMD
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
Contractor's License Law for the reason(s)indicated below by the h dous material repop".rf
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oer o No
Business and Professions Code).Any city or county that requires a permit to S;;O� Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OW ENT
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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRPI
License Low(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
a nd the basis for the alleged exern ption.Any violation of Section 7031.5 by residence or childca re 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 1,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.epa.gay/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 Contractor's 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 a re not intended or offered for Certified Firm Name:
sa le.if,however,the building or improvement is sold within one yea r 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. a No EPA Lead-Safe Certified Firm is required for this project because:
ci 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
City of Menifee
�3ullding & soetV Dept. . ..... Menifee
Adwk��-
DATE AUG 2 4 2016 PERM IT/PLAN CHECK NUMBER
TYPE: F-2�fttjfeKo RESIDENTIAL F-JMULTI-FAMILY []MOBILEHOME []POOL/SPAE]SIGN
I %�-,� -nACCITIONEJALTERATION []DEMOLITION [:]ELECTRICAL []MECHANICAL
SUIBTYPE�
EDNEW [-]PLUMBING E]RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK T-mobile(1)new 24"Microwave Dish, (1)ODU behind the dish, and(1) 1/2 line to the
existing tower. (T-Mobile site number IE95146A)
PROJECTADDRESS 3130OHaunRd., Menifee, CA92584
ASSESSOR'S PARCEL NUMBER 360-230-017 LOT TRACT
PROPERTY OWN EIR'S NAME CROWNCASTLE
ADDRESS 38 Technology Or Suite 250 Irvine, CA 92618
PHONE (949) 930-7463 EMAIL
APPLICANT NAME Luzine Rawls(Coastal Business Group, Inc.)
ADDRESS 24310 Moulton Pkwy, SuiteO#1009 Laguna Hills, CA92637-3306
PHONE 949.336.1550 EMAIL lrawls(Pcoastalbusinessgroup.net
CONTRACTOR'S NAME N/A OWNERBUILDER? [-]YES[-]NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION $ 15-000 SO FT L SO FT
I-APPLICANT'S,SIGNATURE DATE--
DEPARTMENT DISTRIBUTION SMIP CI I Y Ul-MtNIFEE BUSINE55 LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE PAID AMOUNT
AMOUNT
I I CASH 0 CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CASH 0 CHECK# 0CREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0" No DL NUMBER NOTARIZED LETTER '0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92585 951-672-6777
www.cityofmenifee.us;Inspection Request Line 951-246-6213