PMT17-01453 City of Menifee Permit No.: PMT17-01453
29714 HAUN RD.
�!-�CCELA-' MENIFEE, CA 92586 Type: Sign-Permanent
MENIFEE Date Issued: 0 510 8/2 01 7
PERMIT
Site Address: 30164 HAUN RD, MENIFEE, CA 92584 Parcel Number: 360-690-027
Construction Cost: $23,000.00
Existing Use: Proposed Use:
Description of REPLACE 4 SETS OF CHANNEL LETTER SIGNS
Work:
Owner Contractor
DONAHUE SHRIBER REALTY GROUP THE SIGNS AND SERVICES COMPANY
200 E BAKER ST#100 10980 BOATMAN AVENUE
COSTA MESA, CA 92626 STANTON, CA 90680
Applicant Phone:7147618200
RYAN YBARRA License Number:624675
THE SIGNS'AND SERVICES COMPANY
10980 BOATMAN AVENUE
STANTON,CA 9DS80
Fee Description ON Amount ISI
Sign Permit 4 214.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 10.70
$252.70
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_Pe=It_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 ❑I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. ( r the following reason:
License Class C( �1 License No. (.2 l,1 I b � > By my signature below I acknowledge that,except for my personal residence
Expires 3 I Signature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION OECIARATI N 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
this permit is issued. www.leginfo.ca.gov/calaw.html.
Policy# Date
)I`J 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 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 Pr rr In Z.N 5 C. O with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Z01wG#'L574R00 Expires l entertheabove identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundreda. Date IS- 9 —1 7
dollars($100)or less ft(VIERTYCIVAER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued, O�Jdf��
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,I shall fo hwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date S 6 '� mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FA LURE TOf CURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes IfN0
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 requires permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SC construction
or See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Airllnes
Qua
CONSTRUCTION LENDING AGENCY ❑Yes 4dJo
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 ONO
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
checkmark(s)1 have placed next to the applicable item hazardous material reporting.
s)(Section 7031.5 yes ❑No c5�fir}
Business and Professions Code).Any city or county that requires a permit to /
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 YkQWRTY CANER OR AUTHORIZEDAGENT
that he or she is licensed pursuantto the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRPI
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 far most work that disturbs paint in apre-1978
of not
and the casts for the alleged exemption.Any violation of Section residence or childcare facility to be RRP-certified firms and comply with
than
Applicant fora permit subjects the applicant toacivil penalty of not more required practices.This Includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves orthrough their
❑1,as owner of the property,or my employee with wages as theirsole 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).
Cade;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:
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.
IT/PLAN& SAFETY PERM APPLICATION
Menifee
DATE �} — PERMIT/PLAN CHECK NUMBER I I
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 34SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK (1LL E; a C (f7T�tC
PROJECT ADDRESS 3 U
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNERNAME vn t1vl, S L kr. 6Gt o .i
ADDRESS 200 F. K A !`�°'- S 4-, S+c 10 0
PHONE 1 !y - g 6 6 - G 5 3 O EMAIL
APPLICANT NAME F ya-1 Y to C,( (a
ADDRESS C) � ('j n p1�OQ41V�a. "A'`/C vA
L(
PHONE L} � �-} 'y - Zu9L EMAIL Yai\wl+1 VA S+tIICkf CO
CONTRACTOR'S NAME T e- $: 0 ef, Cc OWNER BUILDER? O YES
BUSINESS NAME ,,l f�
ADDRESS 7 8 " &,A �A-,If-^ p�n +(j C_A 90 /b� O
PHONE _� I y - 7I J- 8ZO J EMAIL
CONTRACTOR'S STATE LIC NUMBER 6 2 L] LICENSE CLASSIFICATION y S
VALUATION $ O 0 U SQ FT L SO FT
APPLICANT'S SIGNATURE '`( DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LIAISE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ( SMIP
INVOICE r PAID
AMOUNT 5 AMOUNT O CASH 0 CHECK N O CREDIT CARD VISAIMC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# 0CREDIT CARD VISAIMC
OWNER BUILDERVERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213