PMT16-02987 City of Menifee Permit No.: PMT16-02987
29714 HAUN RD. Type: Sign-Permanent
-1;kCCELA-31 MENIFEE,CA 92586
MENIFEE Date Issued: 0910812016
P E R M I T
Site Address: 30054 HAUN RD, MENIFEE, CA 92586 Parcel Number: 360-69D-027
Construction Cost: $900.00
Existing Use: Proposed Use:
Description of INSTALL TWO ILLUMINATED CHANNEL LETTER SIGN INSERTS ON EXISTING MONUMENT
Work: "FOREVER 21"
Owner Contractor
DONAHUE SCHRIBER CENTERLINE SIGNS
200 E BAKER STREET,#100 10833 CHERRY STREET
COSTA MESA, CA 92626 LOS ALAMITOS, CA 90720
Applicant Phone:5626183707
JAMES KAKALLIS License Number. 1013962
CENTERLINE SIGNS
10833 CHERRY STREET
LOS ALAMITOS, CA 90720
Fee Description Qtv Amount($
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 buillding operations being carried an 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 BldgPernfit-Ternplate.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 contmctor(s)pursuant to the Contractors State License Law),
Chapterf)(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 and my license is in full force and effect. the following reason:
LicenseClass t--L45 License No. 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
cl� improvements covered by this permit.I cannot legallysell 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:1, licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure forworker's 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 webside:
by Section 3700 of the Labor Code,for the performance of work for which www.Ieginfo.ca.Aov/caIaw.htmI.
this permit is issued.
Policy# PROPERTY OWNER OR AUTHORIZED AGENT Date
ci 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 o 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
)"E� ertify 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#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation p.rovipspps of Section 3700 of the Labor
Code,I shall Will the applicant or future building occupant handle hazardous material or a
Applicant=7��'Date ey, 0y. 1,4 mixture containing a hazardous material equal to or greater that the
41� amounts specified an the Hazardous Materials Information Guide?
WARNING.FAILURE TO SECURE WORKEWS COMPENSATION COVERAGE IS oYes allo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or futu re 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(SCAOM D)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguldelines
CONSTRUCTION LENDING AGENCY uYes ciNo
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 n No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCACXMD
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 ciYes ci No
Business and Professions Code).Any city or county that requires a permit to Date
construct,after,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
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRPJ
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Ru le 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 th e 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 renta I property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
a 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( )portion of the work,and the structure is www.epa.goy/lead or contact the National Lead Information Center at
not Intended or offered for sale.(Section 7044,Business and Professions I-BOD-424-LEAD(5323).
Code;The Contractoes 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 oi 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;
a 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 RAP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
ldolllklb�__ �
DATE PERMIT/PLAN CHECK NUMBER 9MQ-naqS-1
Clty c f Menitee
TYPE; 0 COMMERCIAL 0 RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOLIFSPA 0 Smmlding I Safety Dopi
SUBTYPE: OADDITION CALTERATION C-DEMOUTION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES_ SEP 0 8 2U*iI)
DESCRIPTION OF WORK eived
C+AAWNI&L 1w e-yc �-Fx" II-Auxjx T-4Ek"awT- ?6(c U-C-0
PROJECTADDRESS 306 6-Lt 12� 0=1 nBu
ASSESSOR'S PARCEL NUMBER ?koO - (jflf)7_� LOT TRACT
OWNER NAME sIoo Ae
ADDRESS :k�JC)o CCt�� t�::LCW_(nA a@UQU
PHONE EMAIL
APPLICANT NAME -TAt--LC-�< V��CALLU-,�
ADDRESS /Dg-3 7 Ckt-a-te j?y S T , �6s /1 (P4 04,r-M C-4 �'67Z
PHONEA-6 7 ?76,7 EMAIL
CONTRACTOR'S NAME
6t-tPIqN'-/ OWNER BUILDER? 0 YES'"0
BUSINESSNAME
ADDRESS lbf)3 6t&—rCrO �e S-r J�� 6661dr7v Co F677-0
I b
PHONE(-E/11-3767 EMAIL lav-0&�0-4�94 t4i-fta,e
CONTRACTOR15.STATE LIC NUMBER LICENSE CLASSIFICATION J c-Ll 5-4
VALUATION$4, .56 SJQ FT 2-6�L3 LSQFT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPAKTMENT UlbTRIBUTION LI I Y U�FOLWEE BU51NESS LICENSE NUMBEK
BUILDING PLANNING ENGINEERING FIRE I GREEN SK41P
INVOICE I e PAIDAMOUNT '10
AMOUNT �Pj.eo 1 1@ 0 CASH 0 CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES I PAIDAMOUN.T 1 0 CASH 0 CHECK# OCREDITCARD VISAIMC
OWNER BUILDER VERIFIED 0 YES 0 No DLNUMBER NOTARIZED LETTER 0 YES 0 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
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