PMT17-00518 City of Menifee Permit No.: PMT17-00518
29714 HAUN RD. Type: Commercial Electrical
'CXCCEL/? MENIFEE, CA92586
MENIFEE Date Issued:
03/16/2017
PERMIT
Site Address: 31535 BRIGGS RD, MENIFEE,CA 92584 Parcel Number: 372-090-033
Construction Cost: $450.00
Existing Use: Proposed Use:
Description of INSTALL 200 AMP TEMP POWER POLE FOR MENIFEE HEIGHTS TR 32277-2
Work:
Owner Contractor
PARDEE HOMES TEMP POWER SYSTEMS
1250 CORONA POINTE CT#600 625 S FEE ANA STREET
CORONA,CA 92879 PLACENTIA, CA 92807
Applicant Phone:7142235607
WAYNE MCCOY License Number:696713
TEMP POWER SYSTEMS
625 S FEE ANA STREET
PLACENTIA, CA92807
Fee Description Oft Amount l$)
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
$368.62
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_Bldg Pennit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe projects
I hereby affirm under penalty of perjury 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 o I am exempt from licensure underthe Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class 0-10 Lice o. WCRo'7)3 By my signature below l acknowledge that,except for my personal residence
Expires 1 OAJ I c201 E- Signature s in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
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 copy 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 this application is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which wWW.Ieginfo.ca.gov/caIavv.html.permit is issued.
Policy It Date
fm'1 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 o By my signature below I certify to each of the following: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: application and the information I have provided is correct.I agree to comply
Carrier VVL lM& G�yr,4(io f eW-5, 60it-. . C y- with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#"7WVv.00 01Si C4 Expires /D 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#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,lshall fo complywith those provisions. Will the applicant or future building occupant handle hazardous material pro
Applicant Date !IQ mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SE RE KE 'S COMPENSATION COVERAGE IS ❑Yes �Fto
UNLAWFUL,AND SHALL SU ECf EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ON UND D THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE C05T OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SC construction
or modification
permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo Coast
Air ro�es
CONSTRUCf10N LENDING AGENCY oYes ci a
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) oyes "a
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I 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 25505 and 25534 concerning
hBeardou erial reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Dy o
Business and Professions Code).Any city or county that requires a permit to Date 3 z IP 1
construct,alter,improve,demolish or repair any structure,prior to Its pROPERTY O `HOR D A ENT
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 Contractors State EPA RENOVATION REP I AN P INTING fRRPI _
License Law(Chapter9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt from licensure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
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($S00). 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 sale 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.aov/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 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. ❑No EPA Lead-Safe Certified Firm Is required for this project because:
❑1,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.
r
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Men'fee
DATE PERMIT/PLAN CHECK NUMBER j!M1177 0'51
16
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION gr ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK I w` z-�--r' u_ t w --
�4cp_
PROJECTADDRESS z7�Gii r3Zi� C� 2�y0, • Mery GEC °Ia53
ASSESSOR'S PARCEL NUMBER 3�a' Cg �� -J;J LOT TRACT
OWNER NAME �PPrzOGu-
ADDRESS lamp mewl,
PHONE clSl- 4a8L- 4ypO EMAIL
APPLICANT NAME
ADDRESS s- T• 0LAClE:Nrlq C,4 - 01J•S--7O
PHONE 7 14- EMAIL vx 9Dv-E3f_ C-ID
CONTRACTOR'S NAME TIE mp 9t S OWNER BUILDER? 0 YES NO
BUSINESS NAME p Fp Q� s t,
ADDRESS le rEE' ANR �-T- • 91�nCE T-1 ca. `3 r-'T C>
PHONE -I 14- 3oL-t " "e6 S- EMAIL Wf; Nc N PPow E:X- �- M
s
CONTRACTOR'S STATE LIC NUMBER tp9Lp-7/3 LICENSE CLASSIFICATION
VALUATION $ 4 y5 SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE a 1 a a l a c/
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING E INEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT 0CASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee. Building &Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-5777
www.cityofinenifee.Us Inspection Request Line 951-246-6213
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