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PMT17-00093 City of Menifee Permit No.: PMT17-00093 29714 Type: Commercial Electrical �CCEL/� MENIFEEEE,, C CA 92 92586 MENIFEE Date Issued: 04/27/2017 PERMIT Site Address: 30225 GREAT OAK RD, MENIFEE, CA Parcel Number: 360-080-076 92584 Construction Cost: $500.00 Existing Use: Proposed Use: Description of INSTALL SINGLE PHASE METER PEDESTAL, 12 KV Work: Owner Contractor STARK MENIFEE LAND, LLC T B U INC 11990 SAN VICENTE,#200 244 MAPLE AVENUE SUITE T LOS ANGELES, CA 90049 BEAUMONT, CA 92223 Applicant Phone: 9517690647 JARED GROMLY License Number: 781050 244 MAPLE AVENUE SUITE T BEAUMONT, CA 92223 Phone:9494419424 Fee Description Olt Amount l$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 $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. AA_aldg_Permit Template.rpt Page 1 of 1 CITY OF MENIFEE (Chapter9 ENSED DECLARATION property who builds or improves thereon,and who contracts for the projects reby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law), (commencing with section 7000)of Division 3 of the Business and o 1 am exempt from Iicensure underthe Contractor's State License Law for fessions Code and my license is in full force and effect.. the following reason: nse Class CIY ,L y License No. 70 U By my signature below I acknowledge that,except for my personal residence Expires � b S' Signature f� �t in which I must have resided for at least one year prior to completion of W RKER'S COMPENSATION BECARA71ON improvements covered by this permit.I cannot legallysell a structure that have built as an owner-builder if It has not been constructed in its entirety by I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a mpy of the applicable law,Section have and will maintain a certificate of consent of self-insure for workers 7044 of the Business and Professions Code,is available upon request when compensation,issued by the Director of Industrial Relations as provided for by Section 3700°fthe Labor Code,for the performance of work for which this application is submitted or at the following website: this permit is issued. www.leginfo.ca goy/calaw html. 2PO n'it Date I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below 1 certify to each of the fallowing:I am the property this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this number are-�..J t� application and the information I have provided is correct.I agree to comply Carrier_ �W4CDJ- (0AIR9;1X with all applicable city and county ordinances and state laws relating to '7- ,'I q 2�1 �/� building construction.I authorize representatives of this city or county to Policy# TAi K W02 23� Expires t y� enterthe above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred dollars($100)or less Date PROPERTY OWNER OR AUTHORIZED AGENT o I certify that in the performance of the work for which this permit is Issued, I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# workers compensation laws of California,and agree that if I should become ZARDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 3700 of the Labor Co e,I shall fo�rt7hwih comply with hose provisions. Will the applicant or future building occupant handle hazardous material or plicant fd./l. 7 Date mixture containing a hazardous material equal to or greater that the amounts sPPJ,R'cified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE Is o Yes dNo UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN Will the intended use of the building by the applicant or future building ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist for guideli CONSTRUCTION LENDING AGENCY o Yes No 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 hour}dary ofa school? (Section 3097 Civil Code) o Yes No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that l am exempt from the permitting checklist.I understand my requirements under the State of Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 2550S and 25534 concerning checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 bar dous material reporting. Business and Professions Code).Any city or county that requires a permit to es z construct,alter,improve,demolish or repair any structure,prior to its Date issuance,also requires the applicant for the permit to file a signed statement PR ERTY OWNER OR AUTHORIZED AGENT that he or she is licensed pursuant to the provisions of the Contractors State PA RENOVATION,REPAIR AND PAINTING LRRPI License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt from]!censure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint in a pre-1978 an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to be RRP-certified firms and comply with than($500). required practices.This includes rental property owners and property managers who do the paint-disturbing work themselves or through their o I,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.eoa.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 Contractors State License Law does not apply to an owner of a property who,through employees'or personal effort builds or improves the o An EPA Lead-Safe Certified Renovator will be responsible for this project 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 completion,the Owner-Builder will have the burden of proving that it was Firm Certification No.: not built or improved for the purpose of sale. u No EPA Lead-Safe Certified Firm is required for this project because: ❑I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors 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. DATE WA kin PERMIT/PLAN CHECK NUMBER TYPE: ❑COMMERCIAL []RESIDENTIAL []MULTI-FAMILY []MOBILE HOME POOL/SPA SIGN SUBTYPE: ADDITION .ALTERATION DEMOLITION []ELECTRICAL []MECHANICAL ❑N//EW []PLUMBING ❑RE-ROOF-NUMBER OF SQUARES PDESCRIPTION OF WORK ' QZ PROJECTADDRESS '*0 Z �W�Lj ,� Oj -t , ASSESSOR'S PARCEL NUMBER .apQ- Ine J• O7(O LOT TRACT PROPERTY OWNER'S NAME (�{��lP•�co ADDRESS o C I �,yl -✓1 1 Pi �L'-�� it 1 r e- �L./L�g) PHONE 3��- `� J ) EMAIL APPLICANTNAME F(�jU jam' y ADDRESS / G}cli/ _ PHONE �j�ll.�j© '.- / J7f'� EMAIL -r CONTRACTOR'S NAME p-mu p�,C OWNER BUILDER? YES NO BUSINESS NAME 1 y Q ADDRESS �/'Y� AQ T e PHONE �5/-7(oq�Orp�[� EMAIL �D4Uicj (FTIEC(=j C #Ur . CONTRACTOR'S STATE LIC NUMBER 7$/O0-C) LICENSE CLASSIFICATION A VALUATION$ ow SO FT L SO FT APPLICANT'S SIGNATUR DATE A -Z0 DEPARTMEIT DISTRIBUTION - CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERMG FIRE GREEN SMIP X 3 INVOICE AMOUNT PAID AMOUNT I -'CASH ._CHECK# -'CREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT J CASH CHECKS Q CREDIT CARD VISA/MC OWNER BUILDER VERIFIED YES L: NO DLNUMBER NOTARIZEDLETTER C YES 0 NO fEB 2-1 2011 Office Copy