PMT16-03005 City of Menifee Permit No.: PMT1 6-03005
29714 HAUN RD. Type: Sign-Permanent
<A-(—CELA�' MENIFEE,CA92586
MENIFEE Date Issued: 09109/2016
PERMIT
Site Address: 30035 HAUN RD, MENIFEE, CA 92584 Parcel Number: 360-080-062
Construction Cost: $7,000�00
Existing Use: Proposed Use:
Description of INSTALL 2 ILLUMINATED CHANNEL LETTER WALL SIGNS FOR"WEST COAST DENTAL&
Work: ORTHODONTICS
Owner Contractor
HAUN NEWPORT FRANK&SON INC
1000 IN WESTERN AVE 1720 W SLAUSON AVENUE
SAN PEDRO, CA 90732 LOS ANGELES,CA 90047
Applicant Phone:3232913333
FRANK BANG License Number:979879
FRANK&SON INC
1720WSLAUSON AVENUE
LOS ANGELES,CA 90047
Fee Description 0tv Amount($
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 building 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 commencedArithin 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__B1dg_PermR Template.rpt Page 1 of 1
r CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractorls)pursuant to the Contractors State License Law).
Cha pter9�comm encing with section 7000)of Division 3 of the Business a n d a I am exempt from iicensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class c4r- 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
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structu re that I
have built as an owner-builder if it has not been constructed in Its entirety by
a I hereby affirm under pena Ity 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-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 application is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.Ieginfo.ca.Roy/calaw.htmI.
!�o 0--?-�7 Date
Policy PROPERTY OWNER OR AUTHORIZED AGENT
,I hv:and will maintain workees compensation insurance,as required by
she�lpo%37010 o1st1'e La bor Cod e,fo r th e p erform a noe of th e wo rk for wh ich a By my signature below I certify to each of the following:I am the property
t s it ,
'is u d.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
Car L70 with all applicable city and county ordinances and state laws relating to
ner &4� building construction.I authorize representatives of this city or county to
Policy# 90bLei;l='r—t k Expires enter the a bove 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
ci I certify that in the performa nce of the work for which th is permit is issued,
I shall not am Ploy any persons in a ny 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 _I
/C de,I shall lorthwit omply with those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
-L-A plicant Date 0
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ,Yes ikmo
UNLAWFUL,AND SHALL SUBJECr AN EMPLOYER TO CRIMINAL PENALTIES W T—
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN J use of the building by the applicant or future building
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
forguldelines
CONSTRUCTION LENDING AGENCY ci Yes IN 0
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I hereby affirm that underthe penalty of perjurythere 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) cr Yes -41tNo
OWNER BUILDER DECLARATIONS I have mad the Hazardous Material information Guide and the SCAQMD
-kis-th demtaridnrrymqui m
p r g c-Mc is u
in list u " rid Y
permitting check -I nde I. - mqu re
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I hereby affirm under penalty of perjury that I am exempt from the C lif. "I a S, C. ,Sad" 9 905 ents under the State of
California Health&Safety Code,Section 25505
Contractoes License Law for the reason(s)indicated below by the hz ,r us at I rmI, rt, g and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material re rting.
0
Business and Professions Code).Any city or county that requires a permit to s 0 Date
Op Ty OW 0 0 1 G T
construct,alter,improve,demolish or repair any structure,prior to its ROPERTY OWN R ORA ORI DAGENT
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 Contractoes State Pill
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt from licensor The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
e receiving compensation for most work that disturbs paint in a pre-1978
a nd the basis for the alleged exemption.Any violation of Section 7031.5 by residence or ch ildca re facility to be JUIP-certifted firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more
than($500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
n 1,as owner of the propieft 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.goyflead 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 a 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. a No EPA Lead-Safe Certified Firm is required for this project bemuse:
o 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractoes State License Law does not apply to an owner of a If your project does not comply vvith EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
10"'Menifee
DATE PERMIT/PLAN CHECK NUMBERPA411(o- 0'�V060
TYPE: COMMERCIAL [-]RESIDENTIAL [:]MULTI-FAMILY [-]MOBILE HOME [_]POOL/SPA E]SIGN
SU x BTYPE: [-]ADDITION []ALTERATION E]DEMOLITION [JELECTRICAL FIMECHANICAL
'ERMW [-]PLUMBING [-IRE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK —W& S-z*v,� - WJE.S+ uctsk- It &&kp-
TR-TZ-R HAi-I---f I LgH I RA-17-tt-.> S1 04-S
PROJECTADDRESS -3oo:�s vcwv) ka ,
ASSESSOR'S PARCEL NUMBER '55(00- ()M(Db LOT TRACT
PROPERTY OWNER'S NAME �A De.Ito-t C)
ADDRESS I ne) n 00 ':,3CU& PJ�O C( o
PHONE �'310) t�49- -337-� EMAIL
APPLICANT NAME Vi�
ADDRESS
PHONE EMAIL
CONTRACTOWS NAME E;<P&g, OWNER BUILDEL? E]YES NO
BUSINESS NAME
ADDRESS II 71c) SkAsom 4p- Ar q co q�
PHONE Un`N) ZI-91 — '3 333 EMAIL IX , �)
CONTRACTOR'S STATE LIC NUMBER 1 � 96 �q LICENSE CLASSIFICATION C-
VALUATION$ I rl'000 SO FT LSQFT
APPLICANT'S SIGNATURE DATE 6
KN I A ALIFA 12247 Le I C 14 A Lr
DEPARTMENT DISTRIBUTION pro CITY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE
T
AMOU 0 PAIDAMOUNT SH OCHECK# CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0 CA
1 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd Menifee, CA 92586 951-672-6777
www.cityoftnenifee.us Inspection Request Line 951-246-6213
All,
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