PMT16-04263 City of Menifee Permit No.: PMT16-04263
29714 HAUN RD. Type: Commercial Electrical
<A—CCIEU� MENIFEE, CA 92586
MENIFEE Date Issued: 12/2912016
P E R M I T
Site Address: 26010 PALM BREEZE LN. MENIFEE, CA Parcel Number:
92586 Construction Cost: $500.00
Existing Use: Proposed Use:
Description of INSTALL ONE 20DA U/G TEMP POWER POLE FOR PRODUCTION
Work:
Owner Contractor
DR HORTON S R BRAY LLC
2280 WARDLOW CIRCLE,#100 1210 N RED GUM STREET
CORONA, CA 92879 ANAHEIM, CA 92806
Applicant Phone:7145071881
MIKE MCGEE License Number:980589
S R BRAY LLC DBA POWERPLUS
1210 N RED GUM STREET
ANAHEIM, CA 92806
Fee Description Div 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 cammenced 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 Ternplate.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION 0 lam exempt from licensure under the Contractors'State License Law for the
I hereby affirrin under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that,except for my personal residence in
Professions Code and my license is in full force and effect. which I must have resided for at least one year prior to completion of
License Class License No. improvements covered by this permit,I cannot legally sell a structure that I have
Expires 113711--? Sign bOi t as an owner-building If it has not been constructed in its entirety by licensed
El� contractors. I understand that a copy of the applicable law, Section 7044 of the
WORKER&COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application is
submitted or at the following Web site:
D I hereby affirm under penalty of pedury one of the following declarations* leginfo.ca.gov/calaw.hilml.
I have and will maintain a certificate of consent of self-insure for workers; hill)
compensation,issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy# 0 By my Signature below, I cerfily,to each of the following: I am the property
O� I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behaff. I have read this
section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided 6 correct. I agree to comply
permit is issued.My worloars'compersation insurance carrier and policy number am: with all applicable city and county ordinances and state laws relating to building
Carrier)(1 construction.I authorize representatives of this city,or county to enter the above-
identified property for the inspection purposes.
Polk,y#cf-470':�71001 —Expires 3/310 Property Owner or Authorized Agent Date
(This section need not be completed if the permit is for City Business License# 03 54,2 5�
one-hundred dollars-(_$100)or less)
HAZARDOUS MATERIAL DECLARATION
0 1 certify that in the performance of the work for which this permit is issued,1
shall not employ any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers'compensation laws of California,and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts specified an the Hazardous Materials Information Guide?
Code,I shall forthwith comply with those provisions. DYES ET-NO
Applican,t,_ ko 116 Will the intended use of the building by the applicant or future building
_�Date; occupant require a permit for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Nr Quality Management District(SCAQl See permlitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES P?ft
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building ormodifiedfacility bewithin 1000feetofthe outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES OYES ErNO
CONSTRUCTION LENDING AGEN I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of
agency for the performance of the work which this pernfit is issued (Section California Health&Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous material reporting.
,ETYES ON
yll_�
OWNER BUILDER DECLARATIONS Date
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's I
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5.Business and Professions Code:
Any city or county that requires a permit to construct, alter,improve, demolish, EPA RENOVATION.REPAIR AND PAINTING(RRP)
or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she Is licensed pursuant to the The EPA Renovallon,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law(Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certffied firms and comply with
she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the pamt-disturbing work themselves or through their
a clivil penalty of not more than($500).) employees.For more information about EPNs Renovation Program Visit:
www.epa.gov/lead or contact the National Lead Information Center at
11 1, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(5323).
compensation,will do( )all of or( )porting of the work,and the structure is
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property 0 An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name:
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the Firm Cert1ficallon No.:
purpose of sale).
0 1.' as owner of the property an exclusively contracting with licensed 0 No EPA Lead-Safe Cerfified Firm is required for this project because:
contractors to construct the project(Section 7044, Business and Professions
Code:The Contractor's License Law does not apply to anjowner of a property
who builds or improves%iiecin, and whd:c_9*Phac%,foir 1�I
Lprqjects With a
M��Muudfh FZPA PPP d. fill4 fk.DPP
IN I
'----'N/tenlTee
DATE Z /m PERM IT/PLAN CHECK NUMBER emu- cqags
TYPE: O-COMMERCIAL ORESIDENTIAL CMULTI-FAMILY OMOBILEHOME OPOOL/SRA CSIGN
SUBTYPE: OADDITION OALTERATION 0DEMOUTION CrRICAL 0 MECHANICAL
ONEW CIPLUMBING 0 RE-ROOF-N UMBER OF SQUARES-
DESCRIPTION OF WORK IN5-r.4(-L ONE 240DAI-C 4elk -rvAiw-y /glrx lj',F- fw AApwC-T4fj
PROJECTADDRESS C�/ 0 A*C�tl &Z"a, (w.
ASSESSOR'S PARCEL NUMBER LOT Pt TRACTO 30!�O-7
OWNER NAME be daArpN city of Menii le
ADDRESS Z?.Fb L-WDUQ Ce-.0 fl-f-W100 ., 4,-�-te-NA , CA 5 Z9 t3un.ding De It
PHONE '75-1 - Z2 2-%94) EMAIL DEC 2 0 201 i
APPLICANT NAME ltjeag,�r
C � �%
ReL,u ved
ADDRESS
PHONE IV- Z13 -133 3 EMAIL
aWp4gr, eol,
CONTRACTOR'S NAME OWNERBUILDER? OYESO<O
BUSINESS NAME e. e- 6.
ADDRESS /L/0 &b j;4eA -S ,�vVQA.; CA 414616.
PHONE -21"e- 7(p5,-7.srr-I EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 5io SQ FT LSQFT
APPLICANT'S SIGNA URE DATE----/Z
DEPARTMENT DISTRIBUTION CIFFY OF MENIFEE BUSINESS LICENSE NUMBER
SMIP
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE PAIDAMOUNT
AMOUNT � I I I OCASH OCHECK# OCREDITCARD %flSAIMC
PLAN CHECK FEES I PAIDAMOUNT I I OCASH C)CHECK# OCREDITCARD VISAIMC
OWNER BUILDER VERIFIED OYES 0 No DLNUMBER NOTARIZED LE17ER 0 YES 0 NO
Ci'Lyoj'Menife8BL.,ildingg,Saj'e�vOelartment2,O7l4HcunRd. Me),,ifee. CA925869-�l-672-67.77
v1ww.cit.vOfmemfee.us Inspection Request Line 951-246-621-3
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