PMT16-03790 City of Menifee Permit No.: PMT16-03790
29714 HAUN RD. Type: Commercial Electrical
<^—CCEjILX—> MENIFEE, CA 92586
S.��--- MENIFEE Date Issued: 12/0212016
P E R M I T
Site Address: 24082 BUCKSTONE LN, MENIFEE, CA Parcel Number:
92584 Construction Cost: $500.00
Existing Use: Proposed Use:
Description of INSTALL ONE 200AMP U/G TEMP POWER POLE FOR FUTURE PRODUCTION FOR BROOKFIELD
Work: HOMES
Owner Contractor
BROOKFIELD HOMES S R BRAY LI-C
3090 BRISTOL ST#200 1210 N RED GUM STREET
COSTA MESA, CA 92626 ANAHEIM,CA 92806
Applicant Phone:7145071881
MIKE MCGEE License Number:980589
S R BRAY LLC
1210 N RED GUM STREET
ANAHEIM, CA 928G6
Fee Description QtV 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 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.
Akl3ldg_Perm1t—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).
Chaptei-9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License Law for
Professions Code �cen,,e
,and my in,full force and effect. the following reason:
License Class I LicenseNo. By my signature below I acknowledge that,except for my personal residence
Expires I!, signature in which I must have resided for at least one year prior to completion of
im provements covered by this permit.I ca nnot 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
thereby 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&aIaw.htmL
this permit is issued.,
Policy# & r �?ct Oq PROPERTY OWNER OR AUTHORIZED AGENT Date
a I have and willl maintain worker's compensation insurance,as required by
section 3700 of the La bor 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 an the property ownees behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier?Q� 24e with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policyll '7�,q -?aovZ� Explmsg-3i - 17 enter the above identified property for inspection purposes.
(This section need not to be completed is the Perm it is for one-hundred Date.
dollars($100)or less PROPERTY OWN ER OR AUTHORIZED AGENT
/12mritify 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 CfTY BUSINESS LICENSE# 01,55
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workees compensation provisions of Section 3700 of the Labor
Code,I shall forthwith cc ith.those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant 1/1A, Date (2-9 46 mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILUR TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes �a No
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 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 forguldellnes
CONSTRUCTION LENDING AGENCY oYes rNo
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) oYes IWNo
OWNER BUILDER DECLARATIONS I have mad the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements underthe 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
Business and Professions Code).Any city or county that requires a permit to 'foes o No
Date 2
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWM!�R�R`AUTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursua nt 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-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 Applicant for a permit subjects the applicant to a civil pena Ity 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 property,or my employee with wages as their sole employees.For more information about EPXs Renovation Program visit:
compensation,will do I )all of or I I portion of the work,and the structure is www.epa.gov/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. o No EPA Lead-Safe Certified Firm is required for this project bemuse;
c 1,as owner of the property a in 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 yo ur proje Ct does not com p IV with E PA RRP ru le p lease fi 11 out the R RP
Acknowledgement.
i) r (J h �iC m�1�1 I-kC,-4Jr,0�Nl
Ater).i re e
DATE PERMIT/PLAN CHECK NUMBER Milo
TYPE: &COMMERCIAL ORESIDENTIAL OMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION --eELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES_
DESCRIPTION OF WORK —Itif7-446 o\)AE 2�zA,,Lw alk -7Fze )p4&ze 146 ��o(
1-6e-ralc
PROJEcTADDRESS Tort,�+vmc L*-,
ASSESSOR'S PARCEL NUMBER LOT TRACT 3 1 T3 z.
OWNER NAME 13,td)k-FI64�b h*,Ai�
ADDRESS �010 1),elf7al- 6a 57,q -15.-VA CA '52&-Z6
PHONE ?5,e- +"v/- es"D EMAIL
APPLICANT NAME Al 1/0'r At'llariE
ADDRESS
PHONE 3 3 3 EMAIL
CONTRACrOR'S NAME OWNERBUILDER? OYES4-ffO'
BUSINESS NAME '5'. A- Am Y 4 e e- 1lw4e?k,1,ex
ADDRESS Aj. &b g�r&A 4,vAd,5iA., oA lge(.
PHONE (v S--7 Sr s-I EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 5-00 SO FT L SO FT
APPLICANrs SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE � GREEN SMIP I
INVOICE PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
AMOUNT I I I
EES I PAIDAMOUNT I I OCASH OCHECKN OCREDITCARD VISA/MC
IFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
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