PMT16-03262 City of Menifee Permit No.: PMT16-03262
29714 HAUN RD. Type: Commercial Alteration
<A-CCELA21' MENIFEE, CA 92586
MENIFEE Date Issued: 1110212016
P E R M I T
Site Address: 26815 MURRIETA RD, MENIFEE, CA Parcel Number: 330-250-053
92585 Construction Cost: $20,000.00
Existing Use: Proposed Use:
Description of MODIFICATION TO EXISTING WIRELESS FACILITY, INSTALL 6 DIPLEXERS IN EXISTING CABINET,
Work: INSTALL NEW BATTERY CABINET, REPLACE 3 EXISTING ANTENNAS
Owner Contractor
SUN CITY BIBLE CHURCH H C OLSEN CONSTRUCTION COMPANY INC
26815 MURRIETA ROAD 710 EAST LOS ANGELES AVENUE
MENIFEE,CA 92585 MONROVIA, CA 91016
Applicant Phone: 6263598900
MENIFEE,CA License Number. 177029
Fee Description Qtv Amount 11I
Building Permit Issuance 1 27.00
Additional Plan Review Electrical 158 157.50
GREEN FEE 1 1.00
$185.50
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 thereunderwhen 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.Bldg2ennil-Ternplate.rpt Page 1 of I
I CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who cantracts for the projects
I hereby affirm under penalty of perjury that I a m 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 ci I a in 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 A")f-�, LicenseNo. A-P OZ-5 By my signature below I acknowledge that,except for my personal residence
Expires /zc4SIgnature_ -7/ rA-)QC,4 inwhich I musthaveresided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell 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: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
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.Ieainfo.ca.gov/calaw.htm1.
this permit is issued.
Policy# Date
iki have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
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 a in 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
Carrier �-/C. with all applicable city and county ordinances and state laws relating to
A) Ce7,U-51Qi,)(TiC),0 Cn - iA.JC— building construction.I authorize representatives of this city or county to
Policy#�Z%,i,)r A-OT'7-117(-! Expires (4 1 1 .1 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($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
in I certify that In the performance of the work for which this permit Is issued,
ishalinotemplo any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# 0
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 370D of the Labor
Code,I shall forthwit ith those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant l7m,7 Date Ik 111 ffg2 mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ciYes 4No
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 ON E HUNDRED THOUSAND DOLLARS($100,OOD),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 3705 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY oYes [ANo
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) o Yes p(No
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 affirmi 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 oYes 4' Date IZ /I
Business and Professions Code).Any city or county that requires a permit to
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 IRRPI
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
a nd the basis for the 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 applica nt to a civil Pena ItV of not more req uired p ractices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
ci 1,as owner of the propeft 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 sa le.(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 it was
not built or improved for the purpose of sale. a No EPA Lead-Safe Certified Firm is required for th Is project because:
a 1,as owner of the property a in 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
�Wenlfee
DATE 10/3/2016 PERMIT/PLAN CHECK NUMBER
TYPE: [ZICOMMERCIAL F]RESIDENTIAL []MULTI-FAMILY []MOBILEHOME F]POOL/SPA E1S1GN
SUBTYPE: F]ADDITION [Z]ALTERATION E]DEMOLITION F]EI-EcTRICAL FIMECHANICAL
F]NEW [:]PWMBING El RE-ROOF-NUMBER OF SQUARES 25�11fte
y
DESCRIPTION OF WORK Modification of exidng wireless facility suilding & Safety Dept.
OCT 0 4 2016
PROJECTADDRESS 26815 Muffieta Road, Romoland,CA 92585 Received
ASSESSOR'S PARCEL NUMBER 330-250-053 LOT TRACT
PROPERTY OWNER'S NAME Sun City Bible Church
ADDRESS 26815 Munieta Road, Romoland, CA92585
PHONE EMAIL
APPLICANTNAME Smartlink, LLC on behalf of T-Mobile West,LLC
ADDRESS 18401 Von Kerman Ave.,Suite 400
PHONE 949-933-3918 EMAIL imcconnell@smartlinklic.com
CONTRACTOWS NAME TEID OWNERBUILDER? OYESONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 20,000 SCL FT 280 L SQ FT 280
APPLICANT'S SIGNATURE 141el,� DATE 10/3/2016
67 ry
DEPARTMENT DISTRIBUTION GREEN\ SMIP CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I I
INVOICE I _. I I � OCASH OCHECK#
' T PAIDAMOUNT
AMOUN 0 CREDIT CARD VISA�MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA(MC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZEDLETTER 0 YESO NO
City of Menifee Building &Safety Department 29714 Houn Rd. Menifee, CA 92586 951-572-5777
www.citycfmenifee.u5 Inspection Request Line 951-246-6213