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PMT17-01181 City of Menifee Permit No.: PMT17-01181 29714 HAUN RD. Type: Commercial Electrical 'e—ACCEL/-' MENIFEE,CA 92586 MENIFEE Date Issued: 05/25/2017 PERMIT Site Address: 29259 HERITAGE LAKE DR, MENIFEE, Parcel Number: CA92585 Construction Cost: $1,350.00 Existing Use: Proposed Use: Description of METER PEDESTAL FOR CABLE TV POWER SUPPLY FOR CHARTER Work: COMM UNICATIONS-SPECTRUM-CALATLANTIC HOMES Owner Contractor CALATLANTIC GROUP, INC JOHN GRIFFIN CONSTRUCTION INC 355 E RINCON ST#300 244JASON COURT CORONA, CA 92879 CORONA,CA 92879 Applicant Phone:9512782377 FROSTHOLM RUSSELL License Number.618983 JOHN GRIFFIN CONSTRUCTION INC 244 JASON COURT CORONA, CA 92879 Fee Description ON Amount IEI 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_Bldg_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 1 am under provisions of with a licensed contractors)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 under the Contractor's State License Law for Professions Cade and my license is in full force and effect. the following reason: Ucense Class A-b L-7 t.-)D U lse No.1� 11 I e 1 pG7 93 By my signature below I acknowledge that,except for my personal residence Expires Signature hvvgk W� I in which)must have resided for at least one year prior to completion of improvements 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 ci I hereby affirm under penalty of perjury one of the following declarations:I Ilcensed 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,legiiifo.ca.gov/­`:alatv.li turil. this permit is issued. Polity# ?, J C.r_ 4 BV')Z,gILa' Date PROPERTY OWNER OR AUTHORIZED AGENT D I have and will maintain workers compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which ci By my signature below I certify to each of the following:)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 SELF with all applicable city and county ordinances and state laws relating to n building construction.I authorize representatives of this city or county to Policy#Rk)e u49sLR 4 Expires rJ-3` —Z O I I 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 ci I 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 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,I shally fp�rthwr11t-h� o with t ose provisions. r1 Will the applicant or future building occupant handle hazardous material or a Applicant fQJ111[W� Date -3-401 i I mixture containing a hazardous material equal to or greater that the amounts specified an the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes YNo 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 TO ONE 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(SCAQM D)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguide✓lines CONSTRUCTION LENDING AGENCY oYes d-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 boundary of a school? (Section 3097 Civil Code) oYes OVJo OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD permitting checklist.I understand my requirements under the State of I hereby affirm under penalty of perjurythat I am exempt from the Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning hazardous mateial re rting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Ayes tSNo Business and Professions Code).Any city or county that requires a permit to Date 3-z 1 n construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER 6tl AUTHORIZED AGENT 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,REPAIR AND PAINTING[RRP) License Law(Chapter9(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 u 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( )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 1.800424-LEAD(5323), Code,The Contractors State Ucense Law does not apply to an owner of a ❑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. o No EPA Lead-Safe Certified Firm is required for this project because: o 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. BUILDING , ' . . • Olty Df Menite0 endee fet Dept. Q DATE PERMIT/PLAN CHECK NUMBER © 5 TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN '1`wI3e ION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK B f- -rV oWEP. Sut?L4 MVre-2 DE T L YoQ HAQ.T 2 oM uNl 'iio 5 'c_- PROJECTADDRESS A?*?Lj Fog, S /e/ —4 ASSESSOR'S PARCEL NUMBER LOT TRACT OWNER NAME LIrn1T)L_ ADDRESS PHONE EMAIL APPLICANT NAMEFZOS—jk DLMUPS E.Ll_ ADDRESS PHONE / EMAIL CONTRACTOR'S NAME J oln Cs 1 FC tJJ G014S 1 INC. OWNER BUILDER? O YES ONO BUSINESS NAME ,]p �T: ADDRESS --77 $ o V O PHONE 9jl-L? - ?-3r7/ 7 EMAIL 6rWt F F p L. 5 ML• 1 CONTRACTOR'S STATE LIC NUMBER 618983 LICENSE CLASSIFICATION G -'I A VALUATION$ 1.350-o0 �� )�SOFTFT , - Dn LSQFT tR APPLICANT'S SIGNATURE J'1Ba.d'/I�"�" 1 -�-�-�• DATE 4-lq" l 1 I u i -� .. CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY CIF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT O CASH -�CHECK p O CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT O CASH O CHECK a O CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 1 ENIFE Re:Address Assignment Date: May 24, 2017 Neil R. Winter Meter Pedestal Mayor Matthew Liesemeyer Mayor Pro Tem Greg August To Whom It may Concern, Councilmember The following address have been Assigned: Lesa A.Sobek Councilmember Permit Station New Address PMT17-01181 42+ 17 29259 Heritage Lakes Dr. John V. Denver Councilmember Please contact Craig Carlson at the City of Menifee if you have any questions. Craig Carlson Senior Inspector City of Menifee ccarlsona.cityofinenifee.us 951-672-6777 ext. 119 29714 Haun Road Menifee,CA 92586 Phone 951.672.6777 Fax 951.693843 ✓ww.cityofinen ifee.us