PMT16-03721 City of Menifee Permit No.: PMT16-03721
29714 HAUN RD. Type� Sign-Permanent
<A-CCI=-CA1- MENIFEE, CA 92586
MENIFEE Date Issued: 11117/2016
P E R M I T
Site Address: 30021 HAUN RD, MENIFEE, CA 92584 Parcel Number: 360-080-62
Construction Cost: $5,200.00
Existing Use: Proposed Use:
Description of INSTALL 3 LED ILLUMINATED CHANNEL LETTER SIGNS"ONO HAWAIIAN BBC"
Work:
Owner Contractor
RICH DEVELOPMENT SUCCESS SIGN GROUP
1000 N WESTERN AVE,#200 2812 PECK ROAD
SAN PEDRO, CA 90732 EL MONTE, CA 91731
Applicant Phone:62644418181
HYUK LEE License Number: 896068
SUCCESS SIGN GROUP
2812 PECK ROAD
EL MONTE,CA 91731
Fee Description Qtv Amount
Sign Permit 3 190.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 9.50
$227.60
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_Permit-Templatespt 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 0 1 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— (2- q r-. License No. 0. By my signature below I acknowledge that except for my personal residence
Expires--�'l I I a Signature 1� in which I must have resided for at least one year priDr to completion of
I — V 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
ci 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 www.Ieginfo.ca.gov/caIaw.htmI.
this permit is issued.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
o I have and will maintain workees compensation insurance,as required by
section 3700 of the Labor 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 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 with all applicable city and county ordinances and state laws relating to
Policy# 1 Expires building construction.I authorize representatives of this city or county to
enter the above identified property for inspection purpos�.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or ios PROPERTY OWN ER OR AUTHORIZED AGENT
u I certify that in the performance of the work for which this permit is Issued,
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 comply wi h tho ions. Will the applicant or future building occupant handle hazardous material or a
Date mixture containing a hazardous material equal to or greater that the
Applicant—4 1 !M= -LL(21 -1�1 L. amounts specified on the Hazardous Materials Information Guide?
WARNING:FAIL6RE TO SECURE WORKERS COMPENSATION COVERAGE IS oYes 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 ATTORN EYS FEES forguldelines
CONSTRUCTION LENDING AGENCY a Yes u No
I hereby affirm that under the pena Ity of perjury there is a construction Will the proposed building or modified facility he within 1000 feet of th e
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) oYes allo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
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
Contractoes 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 a No
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 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
Ulcense 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 exern ption.Any violation of Section 7031.5 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
a 1,as owner of the propeft or my employee with wages as their sole employees.For more information about EPXs Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eva.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Prof�sions 1-900-424-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,th rough em ployees!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. 0 No EPA Lead-Safe Certified Firm is required for this project bemuse:
a 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 PERMIT/PLAN CHECK NUMBER
TYPE: dCOMMERCIAL 0 RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA OSIGN
SUBTYPE: CADDITION OALTERATION 0DEMOUTION VIELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES_
DESCRIPTION OF WORK CZIL_� 1_t�4_r .
PROJEcTADDRESS �IVO Hockv, Le e CA q
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME R�c4 J�2"I 'pw"�A_� ZL C-, Ully 'I
f? SafeW -
,_t4u,Aag�
C 4pffl
ADDRESS /!7vo Al, 1-d e S-�rn Ave�ue, sci,-le zo� 2 0 7_3'4
PHONE �j(), yq7, -;52( E, Vj, 2 q EMAIL NOV 17 26%
APPLICANT NAME -9
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME HVak Lee OWNERBUILDER? OYESOOO
BUSINESS NAME 28h,
AmIlm
ADDRESS 2gl2= P&, k OP 1/731
PHONE 621. �73. gg6 . EMAIL j',1 -?fj cc e 5 57s)�h L(g.00-�j
CONTRACTOR'S STATE LIC NUMBER 9 TWA LICENSE CLASSIFICATION C— tL�__
VALUATION$ 200 SO FT L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP I X I
INVOICE PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISAIMC
AMOUNT lag-l. � aga o6
PLAN CHECK FEES PAIDAMOLINT I I OCASH OCHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 No DILNUMBER NOTARIZED LET-TER 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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