PMT16-03700 City of Menifee Permit No.: PMT16-03700
29714 HAUN RD. Type: Sign-Permanent
<A-CCIELA> MENIFEE,CA 92586
MENIFEE Date Issued: 1111612016
P E R M I T
Site Address: 30125 ANTELOPE RD, MENIFEE, CA Parcel Number: 364-010-003
92584 Construction Cost: $4,800.00
Existing Use: Proposed Use:
Description of INSTALL 2)ILLUMINATED STARBUCKS CABINET WALL SIGNS AT EXISTING RALPH'S STORE
Work:
Owner Contractor
WEINGARTEN REALTY NATIONAL SIGN&MARKETING CORPORATION
3100 BRISTOL ST#420 13580 5TH STREET
COSTA MESA, CA 92626 CHINO, CA 91710
Applicant Phone:9095914742
PATRICK FARANAL License Number:745030
NATIONAL SIGN&MARKETING CORPORATION
13580 5TH STREET
CHINO,CA 91710
Fee Description QtV Amount($1
Sign Permit 1 190.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 9.50
$227.50
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of effors 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_Pe"it 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)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from Hcensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
LicenseClass License No._5`14N Bymysignature below I acknowledge that,except for my personal residence
Expires Signature OiA�, inwhich I musthave resided forat least one year prior to completion of
C/ improvements covered bythis permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARAWON 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.leginfo.ca.gov/calaw.htmi.
Policy# Date
o I have and will maintain worker's compensation insurance,as required by PROPERTY OWN ER 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 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
Carrier �Arl 5 11 N HA V11 IJ with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
enter the above identified property for inspection purposes.
Policy# VZV 1 .5 210 Expires //
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
n 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 fo ith ompi 1Ahse prc�vislon Will the applicant or future building occupant handle hazardous material ore
1 0
int "mp' spr Date
4 mixture containing a hazardous material equal to or greater that the
,2n T W COMP amounts spl/alecl an the Hazardous Materials Information Guide?
.FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0 Yes 0
U NLAWFU L,AND SHALL SU BJECT AN EM PLOYER TO CRIM I NAL P E NALTIES Will thp rintnded use of the bu lid Ing by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant req ube a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Qu Management District SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguldeli es
;ius ily
CONSTRUCTION LENDING AGENCY o Yes./No
I hereby affirm that under the penalty of perjury there is a construction Will the pro d building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer bouo lar'svof a school?
(Section 3097 Civil Code) o Yes /No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCACIMD
permitting checklist.I understand my requirements underthe State of
I hereby affirm under penalty of perjury that I am exempt from the Calif9i/r ia Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the ha;drdous ma erial report.
te
checkmark(s)I have placed ,Xtt,the applicable item(s)(Section 7031.!5 0
Business and Professions Code).Any city or county that requires a permit to Wle� Date/�/Z/Oko
W
construct,alter,Improve,demolish or repair any structure,prior to its Ng�ER OR AUTHORIZED AGENT
0 U
issuance,also requires the applicant for the permit to file a signed statement
T 0 . P P Ih
that he or she is licensed pursuant to the provisions of the Contractor's State 4PA REONOVATION,REPAIR=AND PAINTING IRRP)
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 licensu re receiving com pensation for most work that disturbs pa int in a pre-1978
and the basis for th e a Ileged exem ption.Any violation of Section 703 1.5 by residence or childcare facility to be RRP-certified 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 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 their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do I I 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 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 0 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. o No EPA Lead-Safe Certified Firm is required forthis 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
DATE PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL CRESIDENTIAL CMULTI-FAMILY OMOBILEHOME OPOOL/SPA V'S'*I'GN
SUBTYPE: OADDITION CIALTERATION 0DEMOUTION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK I KI:51-AW IWO (2), LO&,O CAZ-I llrf WAIil
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER 5LOLt-010'003 LOT TRACT
OWNERNAME W61 "r-AT,�J Fj�L--r--f
ADDRESS SIOD e;, J-111� 6a:SrTA MV64, CA Gjj�v�
PHONE -V �) �63 EMAIL
APPLICANT NAME ?X�PWAL- VAVI�All/ dATIWAL,/ I t'
ADDRESS ks�760 �Atl'IA 9f CA 111-In
PHONE EMAIL
CONTRACTORS NAME OWNERBUILDER? 0YESO-N0
BUSINESSNAME A-5 AT�t,I CA-0
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 'q*do SQ FT LSQFT
APPLICANT'S SIGNATURE DATE 14
CITY STAFF USE ONLY
DEFARTMENT UMTRIUUTION 7--ZITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PL4NNJNG ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
AMOUNT I I
PLAN CHECK FEES PAID AMOUNT I I OCASH OCHECK# 0 CREDIT CARD VISAIMC
OWNER BUILDER VERIFIED OYES 0 NO DILNUMBER NOTARIZEDLETTER 0 YES 0 NO
City of Menifee Building &Safety Department 29714 Houn Rd. Menifee, CA92586951-672-6777
www.cityofimenifee.us Inspection Request Line 951-245-5213