PMT16-04013 City of Menifee Permit No.: PMT16-04013
29714 HAUN RD.
<A—CCIEJI-iv�.w MENIFEE,CA 92586 Type: Commercial Electrical
MENIFEE Date Issued: 05/1812017
P E R M I T
Site Address: 28200 PORTSMOUTH DR, MENIFEE, CA Parcel Number: 339-072-013
92584 Construction Cost: $130,000.00
Existing Use: Proposed Use:
Description of NEW CELL TOWER SITE,22'-8"x 20'-0"
Work;
Owner Contractor
FAITH LUTHERAN CHURCH THEWCORPORATION
28200 PORTSMOUTH DR 1643 W ORANGE GROVE AVE
MENIFEE,CA 92584 ORANGE,CA 92868
Applicant Phone:7145328800
License Number.799597
Fee Description City Amount I$)
Power Apparatus 1 150.00
Services, Switchboards, Control Centers&Panels 1 183.00
Receptacle,Switch, Outlet&FWure 1 116.00
Plan Check Fee 205 205.00
Building Permit Issuance 1 27.00
Inspections not specified 1,033 1,032.56
Additional Plan Review Electrical 457 456.72
GREEN FEE 1 6.00
SMIP COMMERCIAL 1 37.00
New Construction Permit Fee 1 598.00
$2,811.28
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 BidgPermit Ternplate.rpt Page 1 of I
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe projects
I hereby affirm under penalty of perjurythat I am under provisions of with a licensed contractor(s)pursuantta the ContractorsState License Law).
Chapter9 commencingwith section 7000)of Division 3 ofthe Business and o I am exempt from licensure underthe Contractor's State License Lawfor
Professions Code and my license is in full force and effect. the following reason:
UcenseClass 319610 ense No. 17Cgis'c� Z
C f By my signature below I acknowledge that,exceptfor my personal residence
Expires�' ?10 /7 Signatur �21L 'If in which I must have resided for at least one year priorto completion of
I I improvements covered bythis permit.I cannot legally sell a structurethat I
WORKERS COMPENSATION DECLARATION T 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 workees 7D44 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 webs1te:
by Section 3700 of the Labor Code,for the performance of work for which WWW.Ieginfo.ca.gov/calaw.htini.
this permit is issued.
Policy# Date
"I'kave and will maintain worker's compensation insurance,as required by PROPERTY OWNER 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 an 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 do.,0� building construction.I authorize representatives of this city or county to
Policy# Expires 7-- 1 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 provisIRns of Section 3700 of the Labor
Cocle,lshal withco ply th thos�risions. Will the applicant or future building occupant handle hazardous material or a
Ap I amounts specified on the Hazardous Materials Information Guide?
7! F�_ Date -c--ir-/7 mixture containing a hazardous material equal to or greater that the
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS oYes ave'
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 ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY o Yes Alo�
I herebyaffirm that underthe penaltyof perjury there is a construction Will the proposed building or modified facility be within 1000feet of the
lending agencyforthe performance of the workwhich this permit is issued outer boundary of a school?
(Section 3097 Civil Code) 0 Yes rrlel�
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 25 and concerning
Contractor's License Law for the reason(s)indicated below by the haz3_rdous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 15Yes 17>0
Business and Professions Code).Any city or county that requires a permit to 5ETafe 4--18'-1 7
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AibENT
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
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 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 property,or my employee with wages as their sole employees.For more Information about EPA!s Renovation Program visit:
compensation,will do 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 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. a No EPA Lead-Safe Certified Firm is required for this project because:
ci 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 12/0812016 PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL [—]RESIDENTIAL [—]MULTI-FAMILY FIMOBILEHOME []POOL/SPA F]SIGN
SUBTYPE: E]ADDITION F]ALTERATION [—]DEMOLITION DELECTRICAL [—]MECHANICAL
E]NEW F]PLUMBING [:]RE-ROOF-N UMBER OF SQUARES
DESCRIPTION OF WORK cell tower-see project description
I k( —
4im-ts-;7� ,ATeekw
PROJECTADDREss 28200 Portsmouth Drive, Sun City, CA 92586
ASSESSOR'S PARCEL NUMBER 339-072-013 LOT TRACT
PROPERTY OWNER'S NAME Faith Lutheran Church of Sun City
ADDRESS 28200 Portsmouth Drive, Sun City, CA 92586
PHONE EMAIL
APPLICANTNAME Claudia Swindle-Cone Development
ADDRESS 3350 E. Birch St,
PHONE (714) 720-5837 EMAIL cswindlegcore.us.gov, 06%��
CONTRACTOR'SNAME TBD OWNERBUILDER? []YES[Z]NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ ono SO FT L SQ FT
APPLICANT'S SIGNATURE ' -=ff�j- DATE 0 -Y- I
CITY STAFF USE ONLY
ULPAK IMENT DISTRIBUTION SMIP CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN
INVOICE I
AMOUNT PAIDAMOUNT 0 CASH OCHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586.951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-5213
fill- Elio,
p mum 182p
ps 4s31 11on-1
e
I I I Itit I
........... --------
pq
A "NOM2.
133331-� To
all �e
) p
co
a a co I
V9
RZ
pa
HIM, 1-15
it 5!
114
0
fill m m gRgi pjj--'
P-0
I
Z T Z E I T -11 ZI-I-I!
A 19
J
fall. . . . . . . . . . .
FAITH
ma
venzon
m
g DR.
28200 PORTSMOUTH
m SUN CITY, CA 92586 15505 SAND CWDN AWNUE. DI
JWNE, WFORM 92618
90.206.7000
N RIVERSIDE OUNTY