PMT17-00692 City of Menifee Permit No.: PMT17-00692
29714 HAUN RD. Type: Commercial Electrical
'mil-�CCEL/-> MENIFEE, CA92586
MENIFEE Date Issued: 03/16/2017
PERMIT
Site Address: 31503 BYERS RD, MENIFEE, CA 92584 Parcel Number: 358-130-039
Construction Cost: $445.00
Existing Use: Proposed Use:
Description of INSTALL 1o0A O/H TEMP POWER POLE
Work:
Owner Contractor
CAPITAL PACIFIC REAL ESTATE TEMP POWER SYSTEMS
4100 MACARTHUR BLVD,#300 625 S FEE ANA STREET
NEWPORT BEACH, CA 92660 PLACENTIA, CA 92807
Applicant Phone:7142235607
WAYNE MCCOY License Number:696713
TEMP POWER SYSTEMS
625 S FEE ANA STREET
PLACENTIA, CA 92807
Fee Description Oft Amount lE7
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 building 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 Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the 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).
Chapter!)(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from Iicensure underthe Contractors State License Law for
Professions Code and my license is in full farce and effect. the following reason:
License Class MCI Lice a Lbcl to-713
By my signature below I acknowledge that,except for my personal residence
Expires JOJ 14 )-Lot&' Signature } inwhich l must have residedforat leastoneyear priortocompletion of
WORKER'S COMPENSATION DJECLALFRATIQNimprovements 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
❑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.IeRinfo.m.goy/mIavv.htmI.permit is issued.
Policy p Date
1 have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
sedion 3700 of the Labor Code,for the performance of the work for which n By my signature below I 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: application and the information I have provided is correct.I agree to comply
Carrier.)11lL ID+`'.--��'t..{{-- h—t---Low en • 6>9s�. . ct-• with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy s-nlvwC0 Expires /O/' enter the above identified property for inspection purposes.
(This section need not to he 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 g
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,I shall f pwi t comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date I Q mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILUR�TO
n0NUND
KE 'S COMPENSATION COVERAGE IS D Yes �No
UNLAWFUL,AND SEMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UD 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 forguide Ines
CONSTRUCTION LENDING AGENCY ❑Yes oWo
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 Cade) ❑Yes halo
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 underthe State of
Contractors Ucense Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
l
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardo eria reporting.
Business and Professions Code).Any city or county that requires a permit to oy o _
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 PROPERTY OR D A ENT
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION REP I AN P INTING RRP
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 Iicensure 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 he 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 properly owners and property
than($500). 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.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 Contractors State License Law does not apply to an owner of a D 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. D No EPA Lead-Safe Certified Firm is required for this project because:
o 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER%I
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION ELECTRICAL C MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES City of Menifee
tj
w mgBtSapety uepl
DESCRIPTION OF WORK INS 'TkaMP Pew-w
PROJECTADDRESS 3 &47,�_ _ �s� _ 3 v y^`
ASSESSOR'S PARCEL NUMBER Ser>— l-eo- LOT TRACT
OWNER NAME c?AplT-pk_ �lpc 14�I e_ Q,ept-, t s
ADDRESS 1 1 Ol7 .A G . bl-e '3417
PHONE q 4°L - u as - ot O 1 t> EMAIL
APPLICANT NAME W/1 Avg AAC (•p
ADDRESS rJ A ?," I a Ei-a
PHONE 71q.— EMAIL I,,,/.} ,� T-t�-ro, PftAj wAt
CONTRACTOR'S NAME T-v--pAP }�o,r„ , S a OWNER BUILDER. O YES NO
BUSINESS NAME —s-e-m P Po,1 i�,t_ s
ADDRESS \-D 2.S l-� 4 -5v-- e -ri 1=1 11 C/A 9a S-7
PHONE 'JI-s(— a.a�,_ Su,pp EMAIL V,,Q vuc q, i'EM'Dplbvt,'a- 6U
CONTRACTOR'S STATE LIC NUMBER LA q tt-7 13 LICENSE CLASSIFICATION C i b
VALUATION$ L4%-I SQ FT L SO FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT �,
AMOUNT O CASH 0CHECKN CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES v' NO DL NUMBER NOTARIZED LETTER 0 YES O NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, C1 92586 951-672-6777
www.cityofinenifeeus inspection Request Line 951-246-6213
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