PMT16-02985 City of Menifee Permit No.: PMT16-02985
29714 HAUN RD. Type: Sign-Permanent
4�k6CEJ�A—> MENIFEE. CA 92586
MENIFEE Date Issued: 09129/2016
P E R M I T
Site Address: 26125 MENIFEE RD, MENIFEE, CA 92585 Parcel Number: 332-230-003
Construction Cost: $2,500.00
Existing Use: Proposed Use:
Description of NEW CAST-IN PLACE MONUMENT SIGN FOR"SCE VALLEY SUBSTATION"
Work;
Owner Contractor
SOUTHERN CALIFORNIA EDISON COMPANY DUMARC CORPORATION
8631 RUSH ST 187 W ORANGETHORPE AVE STE R
ROSEMEAD, CA 91770 PLACENTIA, CA 92870
Applicant Phone:7149930909
ELEMENTS ARCHITECTURE, INC. License Number: 167616
CA
Fee Description Amount($1
Sign Permit 190.00
Building Permit Issuance 1 27.00
Additional Plan Review Building 148 148.37
GREEN FEE 1 1.00
SMIP COMMERCIAL 1 1.00
General Plan Maintenance Fee-Building 1 9.50
$376.87
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 buillding 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 commenoed 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—Temp1ate.rpt Page I of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of a I a in exempt from licensure under the Contractor's State License Law for
Chapter9(commencing With section 7000)of Division 3 of the Business and
Professions Code and my license Is in full force and effect. the following reason:
License [-?, p'. U7 No. I�IV7 L I By my signature below I acknowledge that,except for my personal residence
'ass _� 1�
Vt �I Z 1� Signature
Expires in which I must have resided for at least one year priorto completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARAT(G*---'�) have built as an owner-builder If it has not been constructed in its entirety by
a 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 a nd will maintain a certificate of consent of self-Insu re for worker's 7D44 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.Ieginfo.ca.gcrv&aIaw.htmL
this permit is issued.
Date
Policy# PROPERTY OWNER OR AUTHORIZED AGENT
Fir 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 lam relating to
Carrier iAAI' building construction.I authorize representatives of this city or county to
Policy#16boo%?�'7'1Z 16 Expires 111,17-1-7 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
a I 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#
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 forLwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date 17-91 IL mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING: AI(URC_T�O SECURE WORKEWS COMPENSATION COVERAGE IS oYes oNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL PINES 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)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ciYo riNo
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) oYes oNo
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
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 Dyes 0 No
Business and Professions Code).Any cilty or county that requires a permit to Date-
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement EPA BEN ON.REPAIR AND PAINTING IRRPI
that he or she is licensed pursuant to the provisions of the Contractorrs State
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 pa Int in a pre-1978
and the basis for the alleged exern ption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certiffed firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more requireii 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( I all of or( )portion of the work,and the structure is www.ep .90v/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 u An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,th rough employees!or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sa le.If,however,the building or improvement is sold within one year of Firm Certification No.:
corn pletion,the Owner-Builder will have the burden of proving that it was ri No EPA Lead-Safe Certified Firm is required for this project bemuse:
not built or improved for the purpose of sale.
o 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