PMT16-03473 City of Menifee Permit No.: PMT16-03473
29714 HAUN RD- Type: Commercial Electrical
<A—CCEL/ MENIFEE, CA 92586
MENIFEE Date Issued: 10/2812016
P E R M I T
Site Address: 31896 EATON LN, MENIFEE, CA 92584 Parcel Number:
Construction Cost: $500.00
Existing Use; Proposed Use:
Description of INSTALL ONE 200A U/G TEMP POWER POLE TO SUPPLY POWER TO TRACT HOME PRODUCTION
Work:
Owner Contractor
KBHOME S R BRAY LI-C
36310 INLAND VALLEY DRIVE 1210 N RED GUM STREET
W1 LDOMAR, CA 92592 ANAHEIM, CA 92806
Applicant Phone:71450718811
MIKE MCGEE License Number: 980589
S R BRAY LLC DBA POWERPLUS
1210 N RED GUM STREET
ANAHEIM, CA 92806
Fee Description P!Z 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 errers 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 otherdise 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 GidgPennit—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 contractor(s)pursuant to the Contractors State license Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and u 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 Celt. license No. By my signature below I acknowledge that,except for my personal residence
Expires L13-1 7/_7Signture4� in which I m ust have resid ed 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 pena Ity of perjury one of the following declarations:I licensed contractors.I understand that a copy of the appilca ble 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 Industria I 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.leginfo.ca.gov/calaw.html.
this permit is issued.
Policy# Date
grrfiave 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 ci By my signature below I certify to each of the following:I a m the property
this permit is issued.My worker's com pensation insurance ca nrier and policy owner or authorized to act on the property owner's behalf.I have read this
numberare: 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)6�- building construction.I authorize representatives of this city or county to
Policy#CLJ6Z72!6,T7-7.,,2- —Expires 1//2 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for onehundred Date
dollars($100)or less PROPERTY OWN ER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued, D'%�_4- _<
I shall not employ any persons inanymannersoasto become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOU MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith CO . . s. Will the applicant or future building occupant handle hazardous material or a
5R__ -�_ �Or mixture containing a hazardous material equal to or greater that the
Applicant Date lo-Z7-16 amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS 0 Yes "0
UNLAWFUL,AND SHALL SUBJECTAN 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 o.ccupant require a permit for the construction Or 1110difli from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQM D)?See penmitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTERESI�AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ci Yes AD
I hereby affirm that under the penalty of perjury them is a construction Will the proposed building or modifted 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) a Yes 41-60
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQUID
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 bythe hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 'er6s 0 No
Business and Professions Code).Any city or county that requires a permit to Date /0 Z 2-1�,
construct,alter,improve,demolish or repair any structure,prior to its PROPER-T—YZVVNMOR AUTHORIZED AGENT
issuance,also requires the applica nt 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-1979
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RAP-certilfied firms and comply wilth
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(S500). managers who do the paint-disturbing work themselves or through their
u 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 I 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 owner of a o 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 because:
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 with EPA RRP rule please fill out the RRP
Acknowledgement.
& SAFETY PERMIT/PLAN CHECK APPLICATION
""Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL 0-IfESIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION 0DEMOU-nON e-5LECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-N UMBER OF SQUARES
DESCRIPTION OF WORK JtJ S-rAj I- 6XT- ,aa-.4e 10�� tv of )nIfee
Building & SE fety Dept.
PROJECTADDRESS 447w 4q. OCT 2 2016
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME //1/j Ake v ra d
ADDRESS 5010 ivt,/Ivb w"qLo.Z.) CA lizi,75-
PHONE "IV- (Pil- EMAIL
APPLICANT NAME
ADDRESS
PHONE 19.5,1- -21.3-/33 3 EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 0 YES el`10
BUSINESS NAME 541- 13/Z4�1 Ll c /A
ADDRESS /Z/O JJ- /4� 414410A., 'r*q 9ZF-06
PHONE -21-11 - -76-jr; ')j-S-/ EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 5"V.49 SO FT L SO FT
APPLICANT'S SIGNATURE DATE
IFEE BU55SS410ENSE NUMBER
DEPARTMENT DISTRIBUTION
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAIDAMOUNT
AMOUNT 1,-Zo - I I I OCASH OCHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES I PAIDAMOUNT I 1 0 CASH 0 CHECK# 0 CREDIT CARD VISAIMC
OWNER BUILDER VERIFIED 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.cityofimenifee.us Inspection Request Line 951-246-6213
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