PMT16-03682 City of Menifee Permit No.: PMT16-03682
29714 HAUN RD. Type: Commercial Electrical
-(��CCF-L-A> MENIFEE, CA 92586
MENIFEE Date Issued: 11/2212016
PERMIT
Site Address: 30472 HAUN RD, MENIFEE, CA 92584 Parcel Number: 360-690-001
Construction Cost: $500.00
Existing Use: Proposed Use:
Description of CHRISTMAS TREE LOT WTH ELECTRICAL LINE FOR LIGHTS AND CHAIN SAWS
Work:
Owner Contractor
DONAHLIESCHRIBER
200 E BAKER ST
COSTA MESA, CA 92626
Applicant License Number
MENIFEE, CA
Fee Description Qtv Amount
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 6.45
$163.52
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 buillding 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_Pemn'9-TeMplate.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)pursuantto the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and Q I am exempt from licensure underthe Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class License No. By my signature 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
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 71344 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/calaw.htmi.
Policy# Date
o I 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 ci 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
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 building construction.I authorize representatives of this city or county to
Policy# Expires enter the above i'dentified)"perty for inspection purpos
(This section need not to be completed is the permit is for one-hundred /317--Z�
dollars(S100)or less PROPERfY OWNER OR AUTHORIZED AGENT t—
o I certify that in the performance of the work for which this permit is issued,
Ishallnotemplo 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 comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to orgreaterthat the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS aYes oNo
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 TOONE 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 Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ciYes oNo
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) n Yes a No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCACMD
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 by the hazardous material reporting.
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 ciYes ci No
Business and Professions Code).Any city or county that requires a permitto Date
construct,alter,improve,demolish or repair any structure,priarto 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 7GOO)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 RRP-certified firms and comply with
an Applk:ant for a permit subjects the applicant to a civil penalty of not more required practices.This Includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
o 1,as owner of the property,or my employee with wages as theirsole 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.goyllead 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 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 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. ci 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 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
""Menifee
Ada&
DATE li�,x PERMIT/PLAN CHECK NUMBER
TYPE: WOMMERCIAL 0 RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION 0ALTERATION CIDEMOLITION A*LECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES—
DESCRIPTION OF WORK _ 611ri-Amth aece LaE - City of w nifee
�Ullulllw a ba ety Dept.
PROJECTADDRESS Z04_� 2, HP�a�__ 9d qc-) NOV 14 2016
ASSESSOR'S PARCEL NUMBER SLfr� toje)-r 1319C K864enife
LOT TRACT
Build ng & Safety j
OWNER NAME
ADDRESS z Loo Gg EV 201
PHONE EMAIL pke&, 00 P5/ZL_r CD aceive
APPLICANT NAME Lowe�15> wfzvwPP"/ i
ADDRESS 30q-7-Z Oft
r+
PHONE bD EMAIL �Q 10 e, ff7Z )JeG CON
CONTPACTOR'S NAME 11A OWNERBUILDER? qYF5 -' Nnun)
BUSINESS NAME IV t VT
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 4em— SQ FT L SO FT
APPLICANT'S SIGM DATE
ri,TY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE 6REEN SMIP
INVO` I IV3.6;11 PAIDAMOUNT
AMOUNT I 1 0 CASH OCHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT I I OCASH OCHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED C)YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Deportment 29 714 Haun Rd. Menifee, CA 92586 951-672-6777
www.citycfmenifee.us Inspection Request Line 951-246-6213
Riverside County Fire Department Office of the Fire Marshal Section
R.,maili3Offaii 230M.,ks'St Sla 1W.R1iti,ra1WGA 92501 Fis(951)95�777 F.(M1)%5A866
PaimUessmOffis. 77-933 Las lAim.has Rd..1201 Palm Desen.CA 92211-4111 Mi.1760)863-8886 (a%(760)863 7072
Fire Department Clearance/Release
To: cearlson@cityofmenifee.us;bdvera@cityofmenifee.us; mbinnall@cityofmenifee.us
Fax:
Tract/Parcel Map Tcj ii�— 'I I-,
Permit/Lot#:
Job Site Address:
F-1 Final For Recordation
0 Release For Building Permit(s)
17-1 Shell Final Only(No Tenant)
n Final For Occupancy
n Release For Residential Sprinkler Installation
17 Building Plan Check Fees Paid,Water Requirement Met-if water applicable
1-1 Building Plan Check Fees Not Paid
171 Residential Sprinkler Plan Check Fees Paid
171 Residential Sprinkler Plan Check Fees Not Paid
FKL Other Fees EJ C AP i-
n Fees Not Required
If you should have any questions, please contact the appropriate RiversideC�Iy-Fire Protection Planning office for
further assistance.
Authorizing Signature�o Re=le�6s
L N t�A��
Print Name
FsRm C—R�,aad 511 V 16