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PMT16-03791 City of Menifee Permit No.: PMT16-03791 29714 HAUN RD. Type: Commercial Electrical <A-CCECA?' MENIFEE, CA 92586 MENIFEE Date Issued: 12/0212016 P E R M I T Site Address: 27840 SHORE BREAK CT, MENIFEE, CA Parcel Number: 92585 Construction Cost: $500.00 Existing Use: Proposed Use: Description of INSTALL ONE 200AMP U/G TEMP POWER POLE FOR FUTURE PRODUCTION FOR CAL ATLANTIC Work: GROUP Owner Contractor CAL ATLANTIC GROUP S R BRAY LLC 15360 BARRANCA PKWY 1210 N RED GUM STREET IRVINE,CA 92618 ANAHEIM, CA 92806 Applicant Phone:7145071881 MIKE MCGEE License Number:980589 S R BRAY LLC 1210 N RED GUM STREET ANAHEIM, CA 92806 Fee Description 9-ty Amount 1$) 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 $363.52 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. Ak_B1dg_Perrnit 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 perju ry 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 a I am exempt from licensure under the Contractor's State License Law for Professions Code and rn ;,nse is,infullforce and effect. the following reason: IC '9 — License Class 16,5* UcenseNo. 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 �Cl� 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 T�hereby affirm under pena Ity 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 workees 7044 of the Business a nd Professions Code,is available upon request when com pensation,issued by the Director of Industria I Relations as provided for this appliciftion Is submitted or at the following website: by Section 3700 of the Labor Code,for the performance of work for which www.IegIn1b.ca.gov/caIaw.htmI. this permit is Issued, Policy# & r(-',&�?ci oq c)�Z: PROPERTY OWNER OR AUTHORIZED AGENT Date ci 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 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 pwrier or authorized to act on the property owner's beha If.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 Carrierkt— :j"e LL4-,g I building construction.I authorize representatives of this city or county to Policy# Expires enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for onehundred Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT /'�rflfy that In the performance of the work for which this permit is issued, 0;�64glr 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 workees compensation provisions of Section 3700 of the Labor Code,I shall forthwith coMplYONith those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant. Date mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? No WARNING:FAII.Ufti'T�O SECURE WORKER'S COMPENSATION COVERAGE IS 0 Yes Id UNLAWFU L,AND SHALL SUBJECT AN EM PLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building AND CIVIL FINES UP TO ONE H UNDRED 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 SECrION 3706 OF THE LABOR CODE,INTEREST�AND ATTORNEYS FEES forguldellnes CONSTRUICrION LENDING AGEN u Yes erNo 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) u Yes PNo 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 Contractor's License Law for the reason(s)indicated below by the hazardous material repo i.n checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ;kffies 0 No Business and Professions Code).Any city or county that requires a permit to —Date (2 construct,a Iter,improve,demolish or repair any structure,prior to its PROPERTY OWtJLRPR`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 JRRpj 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 pre1978 and the basis for the a Ileged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply mfith an Applica nt for a perm it subjects the applicant to a civil pena Ity of not more required practices.This includes rental property owners and property then($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( )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 Professions 1-800-424-LEAD(5323). Code,The Contnictoes State License Law does not apply to an owner of a ci 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 bemuse: 0 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 e n fe Is DATE PERMIT/PLAN CHECK NUMBER f7ml 00bll I TYPE* O-COMMERCIAL ORESIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN SUBTYPE: OADDITION OALTERATION ODEMOLITION eELEcrRICAL OMECHANICAL CNEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES— DESCRIPTION OF WORK I N.57-4e-z- a/JE Zw,4iip AI,16; 70/-"p lit-,Fx /al-6 *e ;rarul'-- Adbucva". — PROJECTADDRESS Z,79e/-C : 5;V4e-,c-- Ere,-47e-- C-F. ASSESSOR'S PARCEL NUMBER LOT lie TRACT OWNER NAME Cllk- 4744At—jY-- drea-e ADDRESS Jt1,eAl-4f,4 I'4' Ljy, 1,eUlt-IP-j i�,j ?-Z(�JC- PHONE /&Cv EMAIL APPLICANT NAME Aleagw ADDRESS PHONE IV- 7,13 3 3 3 EMAIL lk�c All co lau"14wr 411, CONTRACTOR'S NAME OWNERBUILDER? 0YES &I60 BUSINESS NAME .5, ye. 9AY zee- ,& /44c?"cr ADDRESS /?-10 jv- &b xr4e�Al :ZA IU6(v PHONE ?Ae- '76,5---7.sr r-1 EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ 5�0 SOFT L SO FT APPLICANT'S SIGNATURE DATE z DEPARTMENT DISTRIBUTION CITY OF MIENIFEE BUSINESS LICENSE.NWMBER 0-2� BUILDING PLANNING ENGINEERING FIRE � GREEN SMIP INVOICE CIOM PAIDAMOUNT AMOUNT M 0 1 1 � 0 CASH 0 CHECK# 0 CREDIT CARD ASA/MC PLAN CHECK FE S I PAIDAMOUNT I � 0 CASH 0 CHECK# OCREDITCARD W5AtMC OWNER BUILDER VERIFIED OYES 0 No DLNUMBER NOTARIZEDLE17ER 0 YES 0 NO C�Ly of Menifee Building&Safety Deportment 29714 HOLm .Rd. h4eni�pa. CA 02586 1051-572-6777 www.dtvo fmenifee.Usinc qo �o Mm NINZ:2 I C-1 z 00 C�I PEN 19 ;a "a 03 n M < m t:F%ao m m LF--U (D 0 < CD CD tip (-L—n 1w rL—n > V-m f