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PMT16-03067 City of Menifee Permit No.: PMT16-03067 29714 HAUN RD. Type: Commercial Electrical '5A-CCF-LA-> MENIFEE, CA 92586 MENIFEE Date Issued: 09/23/2016 P E R M I T Site Address: 29698 Antelope RD, MENIFEE,CA 92585 Parcel Number: 340-060-036 Construction Cost: $5,500.00 Existing Use: Proposed Use: Description of TEMP POWER POLE WITH 200A PANEL,2 SPAN POLES,AND 1 SUBPOLE Work: Owner Contractor PALMILLA HOA ACTION POWER INC 3151 AIRWAY AVE,SUITE IN 20532 CRESCENT BAY DRIVE COSTA MESA, CA 92626 STE. 106 Applicant Phone: 9497098006 STEPHANIE CARLSON License Number:947176 ACTION POWER INC 20532 CRESCENT BAY DRIVE STE. 106 LAKE FOREST, CA 92630 Fee Description Qtv Amount Services,Switchboards,Control Centers&Panels 1 183.00 Building Permit Issuance 1 27.00 Additional Plan Review Building 148 148.37 GREEN FEE 1 1.00 General Plan Maintenance Fee-Electrical 1 9.15 $368.52 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 Bidg_Pemit-Template.rpt Page I of I 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). Chapter9(commencing with section 7000)of Division 3 of the Business and ci I a m exempt from licensure under the Contractor's State License Law for Professions Code and my license is in full force and effect the following reason: License Class License No. -11'7 6 Bym signature below I acknowledge that except for my personal residence Expires5 3 1 /,5_7SIgnature bcxl� 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 WORKEWS COMPENSATION DECLARATION 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 and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Code,is ava lia ble 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.leRinfo.ca.Rov/calaw.html. this permit is issued. Policy# 9 q.5--0 c) —Date ci I have and will maintain worker's compensation insurance,as required by PROPERTY OWN ER OR AUTHORIZED AGENT section 3700 of the La bor Code,for the performance of the work for which n 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 am: application and the information I have provided is correct.I agree to comply Carrier with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy# 5-0 0 -14 Expires LI -V5— 17 enter the above identified property for inspection purposes. 1_05 (This section need not to be completed Is the permit is for one,hundred Date dollars($100)or less PROPERTY OWNER ORAUTHORIZED AGENT ci I certify that in the performance of the work for which this permit Is Issued, Ishallnoternplo 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 workees compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a mixture containing a hazardous material equa I to or greater that the Applicant ID OV, Date 2 3 amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS ci Yes )60 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 ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Qua lity Management District(SCAQMD)?See permitting checklist IN SECRON 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines CONSTRUCTION LENDING AGENCY 0 Yes 960 1 hereby affirm that underthe penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the lending agency forthe performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) ti Yes Ao 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 herebyalfirm 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 pla ced next to the applicable item(s)(Section 7031.5 o&XNO Business a nd Professions Code).Any city or county that requires a permit to Date If—?I 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 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 a nd 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 lleged exemption.Any violation of Section 7031.5 by residence or childmre facility to be RRPcert1fied 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 a nd property than($500). managers who do the paint-disturbing work themselves or through their ci 1,as owner of the property,or my employee with wages as their sole employees.For mom information about EPXs Renovation Program visit: compensation,will do( )all of or I )portion of the work,and the structure is www.epa.Roy/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 o An EPA Lead-Safe Certified Renovator will be responsible for this project property who,through employeesr or personal effort,builds or improves the property provided that the Improvements am 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. o No EPA Lead-Safe Certified Firm is required for this project because: cr 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 RAP rule please fill out the RRP Acknowledgement BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION i NOW- J -""'Menifee DATE 09115/2016 PERMIT/PLAN CHECK NUMBER j!tMLQ o5nion TYPE: FZI COMMERCIAL E]RESIDENTIAL [:]MULTI-FAMILY E]MOBILEHOME [-]POOL/SPA [:]SIGN SUBTYPE: E]ADDITIONE]ALTERATIONE]DEMOLITION R]ELECTRICAL F]MECHANICAL []NEW []PLUMBING F1 RE-ROOF-N UMBER OF SQUARES— DESCRIPTION OF WORK terrippower �k )\ ax)A p'\O�L nity Ot SUJ�ding 6, "W"'F Dept- PROJECTADDRESS SIE? 1 b "— ASSESSOR'S PARCEL NUMBER Ctao- 1)5�1 12 LOT TRACT ,pjN1ed PROPERTY OWNER'S NAME SaRWUQda49WA%FGIaI palx&�-Q-Qa. min ADDRESS Ce)�*a 9DLQU PHONE (951)279-9000 EMAIL APPLICANTNAME StephanieCarlson ADDRESS 20532 Crescent Bay Dr,Suite 106, Lake Forest,CA 92630 PHONE (949)709-8006 EMAIL stephanie@actionpowednc.com CONTRACTOR'S NAME Action Power, Inc OWNERBUILDER? OYESZNO BUSINESS NAME Action Power, Inc ADDRESS 20532 Crescent Bay Dr,Suite 106, Lake Forest,CA 92630 PHONE (949)709-8006 EMAIL stephanje@actionpowe�nc.com CONTRACTOR'S STATE LIC NUMBER 947176 LICENSE CLASSIFICATION C-10 VALUATION$ $5,500-00 SQ FT L SO FT APPLICANT'S SIGNATURE DATE 09/15/2016 1 1 -' %-,�- "Ll": C),� DEPARTMENT DISTRIBUTION CITbF,!MASS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP )C INVOICE PAIDAMOUNT AMOUNT gq!2; — I I C) CASH 0 CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES I PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityefirnenifee.us Inspection Request Line 951-246-6213 AQ. cn # (o 40 r-i- oll 1.6 AD. 46 ob ;2 qk ID (D CD 0 Z CD U) (n CD 0 Z3 0 D 46 CL 0 zr MOO (D �o CD 4 4 ul 1/4 < 0 dk CD CD