PMT16-03311 City of Menifee Permit No.: PMT16-03311
29714 HAUN RD. Type: Commercial Addition
<ACCIELA> MENIFEE, CA 92586
t---A NA-.- MENIFEE Date Issued: 03/23/2017
P E R M I T
Site Address: 27587 LA PIEDRA RD, MENIFEE, CA Parcel Number: 360-110-020
92584 Construction Cost: $1,150.00
Existing Use: Proposed Use:
Description of INSTALL(2)30 FT FLAG POLES,(1)35 FT FLAG POLE
Work: ALL FLAG POLES TO BE INSTALLED PER 35'FLAG POLE CALCULATIONSIDETAILS CTC
Omer Contractor
SANTA ROSA ACADEMY FUSION SIGN &DESIGN INC
27587 LA PIEDRA RD 680 COLUMBIA AVE
MENIFEE,CA 92584 RIVERSIDE, CA 92507
Applicant Phone: 9516829660
MEGAN LENZ License Number:894662
FUSION SIGN&DESIGN INC
680 COLUMBIA AVE
RIVERSIDE, CA 92507
Fee Description ON Amount($
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
Administrative Fee 74 74.18
Additional Plan Review Building 74 74.18
GREEN FEE 1 1.00
SMIP COMMERCIAL 1 1.00
$306.43
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,_Bldg_Permlt—Ternp1ate.rpt Page 1 of 1
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 contractor(s)pursuantto the Contractors State License Law).
Chapterf)(commencing with section 7000)of Division 3 of the Business and o I am 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 C& Cqj-1 ense No. �1 LP(0�)- By mysignature 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
T— improvements covered bythispermit.I cannot legally sell a structurethati
WORKERS 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
this permit Is Issued. www.IegInfo.ca.gov/caIaw.htmL
Policy# 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 a 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 an 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 AV-4-fY (2i5v- �'oto*a�) Irr- with all applicable city and county ordinances and state laws relating to
0 — building construction.I authorize representatives of this city or county to
Policy# W- o-n- (,P-d Expires 4/1 rton 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
ci I certify that in the performance of the work for which this permit is issued,
I shall not em ploy 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 provisions of Section 3700 of the Labor
Code,I shall fort ith com I those provi.sions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant a- N. P-kAA-, Date 3_C;93- I amounts sgAcified an the Hazardous Materials Information Guide?
WARNING:;ATLURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes E/No
UNLAWFUL,AND SHALLSUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the Intended use of the building by the applicant orfuture building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN
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 Qua lity Management District(SCAQM D)?See permitting checklist
for guldelipbs
CONSTRUCTION LENDING AGENCY a Yes �No
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
lend Ing agency for the performance of the work which this permit is issued outer bourarV of a school?
(Section 3097 Civil Code) 0 Yes / '..
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 dous material reporting-
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its
issuance,also requires the applicant for the permit to file a signed st3tement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(FIRM
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 Ncensure
receiving compensation for most work that disturbs point in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childca re facility to be RRP-certified firms and comply With
a n Applicant for a permit subjects the applicant to a civil pena ItV of not more
than($500). required practices.This includes rental property ownemand property
managerswho dothe 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 EPXs Renovation Program Visit:
compensation,will do I )all of or I I 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 1-800-424-LEAD(5323).
Code,The Contractor's State License Law does not apply to an ownerof 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 a re not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold Within one yea r 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 so le. c No EPA Lead-Safe Certified Firm is required for this project because:
u 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.
& SAFETY PERMIT/PLAN CHECK APPLICATION
: ,-Menifee
DATE tc> 1-7 PERM IT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL ORESIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOL/SPA 0-SIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION CELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
,T_
DESCRIPTION OF WORK
PROJECTADDRESS MSSI �CA Vecket �,W
ASSESSOR'S PARCEL NUMBER LOT 10 TRACT
OWNERNAME r
ADDRESS g�� P,- af�JL,(`�I+ '::,-kA r�� tWC(,t A-
PHONE Q:� t� ?Ab- J,�Q C1 EMAIL
APPLICANTNAME
ADDRI or,
PHONE as EMAILMf qan CD-PLvS IC,n S[9M - cc/(Y)
CONTRACTOR'S NAME &��M Sion B QWNERBUILDERJ) OYESONO
BUSINESS NAME
ADDRESS Z�,�rv\z
PHONE a6l- EMAIL
CONTRACTOR'S STATE LIC NUMBER JOJH (Qh-� LICENSE CLASSIFICATION
VALUATION I ISO SO FT L SQ FT
A IC DATE
PPL CANT,:SIGNATURE j
77777=
DEPARTMENT DISTRIBUTION SMIP 00-1 —ESS LICENSE NUMBER
BUILDING PLANNING ENGjAEERINS FIRE GREEN
_T�Y'J
INVOICE
r T
AU N PAIDAMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
MO '
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDERVERIFIED 0 YES 0 NO DL NUMBER 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
0
Office Copy