PMT16-03974 City of Menifee Permit No.: PMT16-03974
29714 HAUN RD. Type: Sign-Permanent
<A—CA--lELA? MENIFEE, CA 92586
MENIFEE Date Issued: 12/0612016
P E R M I T
Site Address: 30155 HAUN RD, Suite#102, MENIFEE, Parcel Number: 360-080-062
CA 92584 Construction Cost: $1,100.00
Existing Use: Proposed Use:
Description of INSTALL ONE ILLUMINATED CHANNEL LETTER SIGN"SPORT CLIPS"
Work:
Owner Contractor
RICH DEVELOPMENT SPEED QUALITY SIGNS
1000 N WESTERN AVE,#200 635 S SANTA FE STREET
SAN PEDRO, CA 90732 SANTA ANA, CA 92705
Applicant Phone:7143568893
RICK DOBBS License Number: 873011
SPEED QUALITY SIGNS
635 S SANTA FE STREET
SANTA ANA, CA 92705
Phone:7143568893
Fee Description Qtv Amount j$)
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 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 Bidg_Permil—Template.rpt Page I of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm underpenalty of perjury that I am under provisions of with a licensed contractor(s)pursuarittothe Contractors State License Law).
Chapter9(commencingwith section 7000)of Division 3 of the Business and o 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 m ust 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
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
this permit is issued. www.leginfo.ca.gov/calaw.htmi.
Policy# Date
I"_ ve and will maintain worker's compensation insur-ance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,forthe 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
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
Carrier ZC4,o building construction.[authorize representatives of this city or county to
POIRCY4�)C 5�0-60-9V� _ExpiZ YZIJ7- enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o 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 shal )se provisions Will the applicant or future building occupant handle hazardous material or a
Applicant F J�ply with th( Date mixture containing a hazardous material equal to or greater that the
_*�kEAAI amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes o No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES IN Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000), 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 a Yes ci No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility he 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 ciNo
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 huardous material reporting.
checkmark(s)I have placed next to the applicable ftem(s)(Section 7031.5 oYes o No
Business and Professions Code).Any city or county that requires a permitto Date
construct,alter,Improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant for the pemnit 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 HRRP)
License Law(Chapter 9(commencing with Section 71100)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 Heensure 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-certlfied firms and comply with
an Applicant for a permit subjects the applicaritto 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
ci 1,as owner of the property,or my employee with wages as theirsole employees.For more information about EPAs Renovation Program visit:
compensation,will do( )all of or 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 c 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 fo r Certified Firm Name:
sale.If,however,the building or improvement is sold within one yearof Firm Certification No.:
completion,the Owner-Builder will have the burden of provingthat ftwas
not built orimproved for the purpose ofsale. o No EPA Lead-Safe Certified Firm is required for this project became:
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 role please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
lkalv
DATE PERMIT/PLAN CHECK NUMBER
TYPE: a��2m-MERCIAL ORESIDENTIAL 0MULTI-FAMILY C) MOBILEHOME 0— POOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
City 0
PROJECT ADDRESS k4 44�W R"IldIna 8,'=DI pt.
ASSESSOR'S PARCEL NUMBER LOT TRACT DEC 0 6 P"'
OWNERNAME
ADDRESS low V.) j),3Mkj?4n )'K�C4;p= sax) QR�A�elvwkl
PHONE 3/() — ZZO 6110 EMAIL
APPLICANT NAME
ADDRESS i-dt- 4=06
PHONE DL EMAIL
CONTRACTOR'SNAME OWNER RU—ILDER? 0 YES "0
BUSINESS NAME
ADDRESS 4', 35- S-, -34.-i,2 i A- Eff Av� A, Cq qZlo'l
PHONE 71�L) 9E(, EMAIL 50-r--&,D 4 4= L kt
7
CONTRACTOR'S STATE LIC NUMBER <621?D011 LICENSE CLASSIFICATION
VALUATION$ 160 Q L SO FT
APPLICANT'S SIGNATURE— DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP I Y% I
INVOICE PAID AMOUNT 0 CASH 0 CHECK# OCREDITCARD VISAIMC
AMOUNT 15hl
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISAIMC
LOWNER BUILDER VERi IED 0 YES 0 NO DL NUMBER NOTARIZED LETTER 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