PMT16-03474 City of Menifee Permit No.: PMT16-03474
29714 HAUN RD. Type: Commercial Electrical
<A-CCEL:A-> MENIFEE, CA92586
MENIFEE Date Issued: 10/28/2016
P E R M I T
Site Address: 28736 ROSE MEADOW DR, MENIFEE, Parcel Number:
CA 92584 Construction Cost: $500.00
Existing Use: Proposed Use:
Description of INSTALL ONE 400A U/G 3 PHASE 240V TEMP POWER POLE AND ONE 400A 3 PHASE
Work: DISTRIBUTION PANEL TO PROVIDE POWER TO LENNAR TR
Owner Contractor
LENNAR HOMES S R BRAY LLC
980 MONTECITO DRIVE, STE 300 1210 N RED GUM STREET
CORONA. CA 92879 ANAHEIM,CA 92806
Applicant Phone:7145071881
MIKE MCGEE License Number: 980589
S R BRAY LLC DBA POWERPLUS
1210 N RED GUM STREET
ANAHEIM, CA 92806
Fee Description city Amount($1
Services, Switchboards,Control Centers&Panels 1 283.00
Building Permit Issuance 1 27.00
Additional Plan Review Building 148 148.37
GREEN FEE 1 1.00
General Plan Maintenance Fee-Electrical 1 14.15
$473.52
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_Permit-Template.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)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from ficensure 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. 24i M7 By my signature below I acknowledge that,except for my personal residence
Expires 1/f///2__Signatue4:�_ in which I must have resided for at least one year prior tocompletion 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 70"of the Business and Professions Code,is available upon request when
compensationo 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.htm1
Policy# Date
olTiave 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 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 are: 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)6L building construction.I authorize representatives of this city or county to
Policy#C"7:rer3*7a?- —Expires 3 6% 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
c I certify that in the performance of the work for which this permit is issued, 0V2_r__
I shall not employ 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 forthwith com s. Will the applicant or future building occupant handle hazardous material or a
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 WORKER'S COMPENSATION COVERAGE IS 0 Yes "o
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
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 "o
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 th a performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) 0 yes AND
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQUID
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
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 grlles o No
Business and Professions Code).Any city or county that requires a permitto Date /0-Z 2-1(,
construct,alter,improve,demolish or repair any structure,prior to its PROPERT—Y—OWNMOR 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(RRP)
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
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be R RP-cerfified 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 ownem and property
than($500). managers who do the paint-disturbing work themselves or through their
a 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 all of or( )portion of the work and the structure;s www.epa.Roy/lead or contact the Naitional Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions I-BOD-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 fbr 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 7D44,Business a nd Professions
Code:The Contnctoes 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
,,,k,,.1Meni1ee
DATE 10-21-16 PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL 0 RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION 0ELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK )N;-r,44(_ OAC 'LICOAY U& _3)91MS45 2V,;�V 7,6;Y. P6"E bu�
OP6 �'004o`r 31A?- bbrlo� AWee -20 11zv'h6 0964C ID a�-AWZ- 7Xe ly U1 M011118b
Building & Safety D( pt.
PROJECTAIDDRESS Z87 5�- At,
ASSESSOR'S PARCEL NUMBER LOT TRACT OCT 2 1 2016
OWNER NAME 4,51vk��x Receivec
18) lle"Mlc�z� a . 57Z CA
ADDRESS -3 U0-9 -0
PHONE '15ri- kr? EMAIL
APPLICANT NAME
ADDRESS
PHONE 1�3r/- zl� 3 EMAIL A1111-EA
CONTRACTOWS NAME OWNER BUILDER? 0 YES
BUSINESS NAME �-A-
ADDRESS Z4 0 IJ- &D 6i 44--t? jivkMF1Aj C.,q '9Z&&
PHONE _21�'- 741� ?r5-1 EMAIL
CONTRACTOR'S STATE LIC NUM13ER LICENSE CLASSIFICATION
VALUATION$ 5,00 — SO FT LSQFT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY NESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE � PAIDAMOUNT
AMOUNT I 1 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT I 1 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 No DLNUMBER NOTARIZED LEITER 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
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