PMT16-02939 City of Menifee Permit No.: PMT16-02939
29714 HAUN RD. Type: Sign-Permanent
<A—CCELA—> MENIFEE,CA92586
MENIFEE Date Issued: 09/0212016
P E R M I T
Site Address: 30051 HAUN RD,MENIFEE, CA 92584 Parcel Number. 360-080-062
Construction Cost: $850.00
Existing Use: Proposed Use:
Description of INSTALL 2 ILLUMINATED WALL SIGNS WILOW VOLTAGE LED LIGHTS, I MONUMENT
Work: REPLACEMENT
Owner Contractor
HAUN NEWPORT, LLC A C ELECTRIC
1000 IN WESTERN AVE#200 8622 STEWART AND GRAY RD
SAN PEDRO, CA 90732 DOWNEY, CA 90241
Applicant Phone: 5622923550
ANTHONY GUEVARA License Number:963058
A C ELECTRIC
8622 STEWART AND GRAY RD
DOWNEY,CA 90241
Fee Description Qtv Amount
Sign Permit 3 190.00
Building Permit Issuance 1 2700
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_B1dg2errnit—TeMp1ate.rpt Page 1 of 1
CITY OF MENIFEE
(ICENSED 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 contmctor(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 underthe Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class C— I a License No. 011, 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
RKER'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
compenSat!Dn,is�sued 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.leginfo.ca.govIcalaw.libril.
this permit is issued.
Policy# PROPERTY OWNER OR AUTHORIZED AGENT Date
o I have and will maintain worker's compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which ci By my signature below I certify to each of the folloWing:I am the property
this permit is issued.My worker's 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 building construction.I authorize representatives of this city or county to
Policy# Expires 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
fff'certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any ma nner so as to become subject to the CITY BUSINESS LICENSE If
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
a,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
plim Date 2 mixture containing a hazardous material equal to or greater that the
amounts specified an the Hazardous Materials Information Guide7
AARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0 Yes 016
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AN D CIVIL FINES UP TO ONE HUN DRIED 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 forguldelln�
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I hereby affirm und
have and will m-it'in a
compensation,il"d by
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ye 1 37
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CONSTRUCTION LENDING AGENCY ci Yes wdo
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) ci Yes lw.�
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 exemptfrorn the California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's 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 S ONO
Business and Professions Code).Any city or county that requires a permit to Date 611-4 /C�
construct,alter,improve,demolish or repair any structure,prior to its \PROPERTYOWNER OR AUTHORIZED AGENT
isisuance,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(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 a Ileged exemption.Any violation of Section 7031.5 by residence or childca re facility to be RAP-certifted 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-citsturbing work themselves or through their
n 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPXS Renovation Program visit:
compensation,will do I I all of or I I portion of the work,and the structure is www.epe.gov/lead or contact the National Lead Infonnation 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 ci 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 kwas
not built or improved for the purpose of sale. a No EPA Lead-Safe Certified Firm is required for this project bemuse:
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
..",- Menifee
A111�141 ke."IT,
DATE PERM IT/PLAN CHECK NUMBER
TYPE: 0160MMERCIAL CRESIDENTIAL 0MULTI-FAMILY OMOBILEHOME 0 POOL/SPA IKSIGN
SUBTYPE: CADDITION OALTERATION CDEMOUTION &ELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES_
DESCRIPTION OF WORK L,-, 4-c
PROJECTADDRESS 00 Aj 1 j2 c.(
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNERNAME e,c C'.j—I Pe J2�, IL
ADDRESS t�a e_ �-Lr )2 1 ck �e
, r
2- C-4
PHONE EMAIL
APPLICANT NAME G ,,jvw--t-
ADDRESS k 3 9 1 14--
PHONE C?0 of
6(� EMAIL
CONTRAcroWS NAME Ay" t- OWNERBUILDER? OYESONO
BUSINESSNAME
ADDRESS 22 � �CLk IVI_ A
%06LXr�e_4 CQ_ 102�ij
PHONE 2-) Z- EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION 6' SO FT LSQFT
ILA
APPLICANT'S SIGNATURE DATE
77 0/4,
DEPARTMENT DISTRIBUTION SMIP CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PIANNING ENGINEERING FIRE GREEN
INVOICE PAIDAMOUNT
AMOUNT CASH C)CHECK# CREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT
1 1 OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LE17ER 0 YES 0- NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-5213