PMT17-02466 City of Menifee Permit No. PMT17-02466
29714 HAUN RD. Type: Sign-Permanent
-�A—CCEL/> MENIFEE,CA 92586
MENIFEE Date Issued:
07/1412017
PERMIT
Site Address: 30098 HAUN RD,MENIFEE, CA 92584 Parcel Number: 360-690-007
Construction Cost: $4,125.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE 2 VERIZON SIGNS. INSTALL 2 NEW ILLUMINATED LETTER SET SIGNS
Work:
Owner Contractor
DONAHUE SCHRIBER TRULITE SIGNS INC
200 E. BAKER STREET SUITE 100 2990 HALF MOON CT
COSTA MESA, CA 92626 NORCO,CA 92860
Applicant Phone:9517355525
NICOLAS NOLTEN License Number:846189
TRULITE SIGNS INC
2990 HALF MOON CT
NORCO, CA 92860
Fee Description Ott Amount($
Sign Permit 2 190.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 9.50
$227.60
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 for the projects
1 hereby affirm under penalty of perjury that I 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 ❑I am exempt from Iicensure under the Contractors State License Law for
Professions Code and
�))my license is in full force and effect.
� the following reason:
License Class
-q Cq License
/No. (� (.I ? By my signature below I acknowledge that,except for my personal residence
Expires le*Ur? Signature '{' 6�Cn�s� 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 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.leginfo.m.goy/calaw.ho-ril.permit is issued.
Policy ff Date
1104ave 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 1 have provided is correct.I agree to comply
Carrier
s, Q-_,e T jJs A'rMi with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy 8 ?if SGO^adb Expires O -2.1 7 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred 0�0 4 40" pate
dollars($100)or less O\j0P p�PERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit �,i �ZGi—� ��
I shall not emolov any persons in any manner so asto become su,bn�jex�,% q`4-Ty BUSINESS LICENSE it .3 ( /
workers compensation laws of California,and agree that if I shoMew ' ® H US MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Lab
Code,I shall forthy th mply with those provisions. G� p��fVr t a applicant or future building occupant handle hazardous material or a
ure containing a hazardous
rial
ual to or greater that
Applicant �I'/ Date �'/�' amounts specified on the Hazardous Materials Information Guide?e
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS '�9 ❑Yes 49No
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 0Yes Ao
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) o Yes jifNo
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 perjury that 1 am exempt from the California Health&Safety Code,Section 25505 and 2SS34 concerning
Contractors License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes Ao -7
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR 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 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 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 workthemselves 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.eoa.eov/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 ❑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:
D 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 role please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECKNUMBERPM-F1--1-0Z4(DLP
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 4 SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
it NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 2
PROJECTADDRESS ? v1NS �{E-tgao
�2 o
ASSESSOR'S PARCEL NUMBER 3(4)D. LOCH . ��/ I LOT C TRACT
OWNER NAME Pbr/a4v p /'+ a
ADDRESS /�o . � + (ij S ( ZC ,6 — S3 Ob
PHONE 7/Y-5YS=/yw EMAIL c,4vu t C; r-k �. C-o
APPLICANT NAME lvm6
hL S A#elN
ADDRESS 2 O IdAllp D79N (�W. N.,-" C0 Fsno
PHONE 47YI-23rS'S'2�" EMAIL 7-r p/'f{ fd
CONTRACTOR'S NAME 7ro hi-t S; 2 K OWNER BUILDER? O YES * NO
BUSINESS NAME -rro 7:ie gzwsc
ADDRESS O ,pAr C4, ovo.-CC), C y' 1 246 O
PHONE EMAIL Try/•Fr
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION C
VALUATION$ 41,12 $' SO FT L SQ FT �7
APPLICANT'S SIGNATURE DATE ?
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF ME2NIFpEE1BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP �.J `� (3C) V//
INVOICE PAID AMOUNT AMOUNT !�! 1' O CASH 0CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES
nO� NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92gu091 ept.
www.cityofinenifee.us Inspection Request Line 951-246-6213
JUL 14 2017
RorPived
�,.- `�•�-"�`'"^tiJ'�•INC.
August 22nd,2016
1
To whom it may concern:
I hereby authorize Nicolas Nolten to apply for,execute,r eive and perform all acts necessary to obtain
planning approvals, building permits,business and of licenses, construction certificates,Title 24 and
all State and local documents related to the issuance of a permit under Trulite Signs Inc. contractor's
license number 846189 and shall remain in full force and effect until written notice is given.
If you have any questions or concerns regarding this authorization please contact me.
Thank you, City of Menifee
_ Building & Safety Dept.
�— Jul 14 26V
Diana Erwin
Trulite Signs,Inc. T
2990 Half Moon Ct p4 e c e ive d
Norco CA 92860
951-735-5525
A notary public or other officer completing this certificate verifies only the identity of the individual who
signed the document to which this certificate is attached,and not the truthfulness, accuracy,or validity of
that document.
State of o it kirlLiLt County of ycrwd-e On 9L-0/�
�teefore me, .-Tent11 r rctJaFrink Przu personally appeared
1: tmct_ rfw"A_l
who proved to me on the basis of satisfactory evidence to be the person/whose name�oare
subscribed to the within instrument and acknowledged to me that A sJ1eAOk executed the same in,fri57
"ir authorized capacityfjes), and that by /fir signature_(s�on the instrument the persoVs<or
the entity upon behalf of which the personffacted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal.
Ji.itlN6:n GAVARRETE ARAUJO
11 , Commission # 2026579
Notary Public - California 'Z'—
f Riverside County a
My Comm. fxpires May 31,20tF'
JENNIf,EN GAVARRETE ARAUJO:
p -"Coinrtlission#2026579 _
rr Notarg•RuElie-Californls _D. �10
Ripan{1rcounty
My Conan. .va 31,2017' ;