PMT17-01277 City of Menifee Permit No.: PMT17-01277
29714 Type: Commercial Electrical
SR►CCELA� MENIFEE,EE,C CA 92 92586
MENIFEE Date Issued: 04/28/2017
PERMIT
Site Address: 30108 SOUTHSHORE DR, MENIFEE,CA Parcel Number:
92584 Construction Cost: $2,000.00
Existing Use: Proposed Use:
Description of INSTALL ONE 10DAMP U/G TEMP POWER POLE TO PROVIDE POWER TO WATER PUMP FOR TR
Work: 30422-3
Owner Contractor
LENNAR HOMES OF CA S R BRAY LLC
980 MONTECITO DR#302 1210 N RED GUM STREET
CORONA, CA 92879 ANAHEIM, CA 92806
Applicant Phone:7145071881
JANE RECKTENWALD License Number.980589
S R BRAY LLC
1210 N RED GUM STREET
ANAHEIM, CA 92806
Fee Description Oft Amount($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_Bldg_Pernit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class C 1 p , C31 License No..ggu�9 By my signature below I acknowledge that,except for my personal residence
Expires ,_ Signature in which I 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
❑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 worker's 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.leginfo.ca.gov/calaw.htm].
this permit Is issued.
Policy q Date
gthave 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 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
� (' with all applicable city and county ordinances and state laws relating to
Carrier fop Jac,
`O building construction.I authorize representatives of this city or county to
Policy p CLJ&1L�k 01?pC-1 Expires J'3\ 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
❑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 R b�tt�--J4 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 forthwith comply y9ose provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant Date '� ' t amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECU RKER'S COMPENSATION COVERAGE 15 o Yes o
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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes r0
1 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) ❑Yes
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
California Health al Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the
hazardous material report,
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5
oyes �Jo
Business and Professions Code).Any city or county that requires a permit to I Date I
construct,alter,improve,demolish or repair any structure,priorto its PROPERTY OWNER OR \U 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,REPAI 0 PAINTING 1RRP)
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 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($500). managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800a424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
zi a ir'I _ e ,a
DATE 4 24.17_ PERMIT/PLAN CHECK NUMBER
I
TYPE: COMMERCIAL VRE$IDENTIAL MULTI-FAMILY N1061LE HOME POOL/SPA SIGN i
SUBTYPE: ADDITION ALTERATION DEMOLITION VELECTRICAL MECHANICAL
NEW PLUMBING RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Install one 100Am U/G Temporary Power Pole to provide _ —?
power to water pump for Southshore Dr Lennar street improvements
PROJECT ADDRESS
ASSESSOR'S PARCEL NUMBER _ LOT TRACT
OWNER NAME Lejnar HOMeS !
ADDRESS 980__Mo..ntecito Dr Suite # 302 Corona,_CA 92879
PHONE 951-817-3500 EIVIAIL
!( APPLICANT NAME Jane Recktenwald
ADDRESS ------------ ------
PHONE 714_336-6159 EMAIL _
CONTRACTOR'S NAME _POWer PIUS _ OWNER BUILDER? Yc'S NO
BUSINESS NAME -
+I ADDRESS 275Q_LNLP_Qr_rT
PHONE 951-2-93-1333 EMAIL _- --
CONTRACTOR'S STATE LLIICNUUMBER 980589 _ _ LICENSE CLASSIFICATION 13 C10 & D31 �
VALUATIONS -2,OQQaQ _—_- SQ-T LSQFT .—I
APPLICANT'5 SIGNATURE DATE 4-24-17
i CE�ARi',liNT CISTR13.i L`tl '. �� ClT OF 4IEM15EE BLSIN SSLC.^:SE NUM71
3U.L7r,,G 7Lam�nVo e4GryEcd >e GREEN—__ __ SMIP
INVOICE
AMUUNI CASH
�//��j/J� I . 1
' (� X ' -- PAID AhiOUNi CAS H CHECK�t CREDIT CARD VISA/MC
i PLAN CHECK FEES RAID AMOUNT '
CASH CHECk" REUIi CARD VISA/MC I
OWNER BUILOER VERIFIED YES NO DL NUMBER --�-_^ NOTARIZED LETTER YES- NO v_
Y� W
lit
k
y, r : }''� n.. \` �^ _ 4 err � I � •
1 1
fit♦ �d: .� __
�r-t 2u1�1.t51.t.�...Y1QS �I
= Z .�
a
E
v m Y
� �
Q0
�`�J CD fV
a �\
CD
m m
N i G ,