PMT17-02550 City of Menifee Permit No.: PMT17-02550
29714 HAUN RD. Type: Commercial Electrical
< -�CCELA? MENIFEE,CA 92586
MENIFEE Date Issued: 0712112017
PERMIT
Site Address: 26875 NEWPORT RD,MENIFEE, CA Parcel Number: 360-030-024
92584 Construction Cost: $500.00
Existing Use: Proposed Use:
Description of INSTALL A 20A 120 VOLT DEDICATED CIRCUIT FROM PANEL TO KIOSK
Work:
Owner Contractor
MCDONALDS AMBIENT ELECTRIC INC
26875 NEWPORT RD 2363 TELLER RD STE 112
MENIFEE, CA 92584 NEWBURY PARK,CA 91320
Applicant Phone:8183097927
AMBIENT ELECTRIC INC License Number:995928
2363 TELLER RD STE 112
NEWBURY PARK,CA 91320
Phone:8183097927
Fee Description 9ht Amount 151
Services,Switchboards, Control Centers&Panels 1 183.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Electrical 1 9.15
$220.15
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 olhervvise slated,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 D�IQN 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 70D0)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License Law for
professions Code and my license is in full force and effect. p the following reason:
License Class ( 10 License Jo. I Z� By my signature below I acknowledge that,except for my personal residence
Expires -3( 0 Signature r 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 DECLARA ION have built as an owner-builder if it has not been constructed in its entirety by
o 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
ip 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.ler;info.a.¢ov/calaw.html.
this permit is issued.
Date
Policy fl
A919—
PROPERTY OWNER OR AUTHORIZED AGENT
V<have and will maintain worker's compensation insurance,as required by
section 3700 ofthe Labor Code,for the performance of the work for which o By my signature below I certify to each of the following:I am the property
this permit is issued.My worker's 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
�It with all applicable city and county ordinances and state laws relating to
Carrier 0(' f1g2Q In/$U 20.rL C2 building construction.I authorize representatives of this city or county to
polity q_I Z v2.C2U I q 1 Expires �1 'I 1 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
eflcertlfy that in the performance of the work for which this permit is issued,
shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE p
workers compensation laws of California,and agree that If I should become HAZARDOUS MATERIAL DECLARATION
subject to the w rke s c npensation provisions of Section 3700 of the Labor
Code,1 shall fo h Eh wid"hose provisions. —1 . Wi0 he applicant orfuture building occupant handle hazardous material or a
Applicant Date — 2 'I 1 mixture containing a hazardous material equal to or greater that the
amounts spe ed on the Hazardous Materials Information Guide.
WARNING: (LURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes
UNLAWFU AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL INES 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 forguidelin
CONSTRUCTION LENDING AGENCY ❑Yes No
j I hereby affirm that under the penalty of perjury there is a construction Will the prop ed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer bou ary of a school?
(Section 3097 Civil Code) o Yes No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAO,MD
I hereby affirm under penalty of perjurythat I am exempt from the permitting checklist.I understand my requirements under the State of
California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the ha rdous material repo ring.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 es o No I
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 O R O A ORIZED 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 RENOVA71 N REPAIR AND PAINTING 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 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
0 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 yearof 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:
❑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.
SAFETY . • APPLICATION
Memee
DATE _ '2 1 PERMIT/PLAN CHECK NUMBER1,;M711-0125S-0
TYPE: COMMERCIAL ❑RESIDENTIAL MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ELECTRICAL ❑MECHANICAL
[-]NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK - r ,✓ ,,,1 sL 'ZO C � RI c u;4-
PROJECTADDRESS 2(0 21 s e µ) o -t' �^� ¢n I Fe 2 � " Z d7�
ASSESSOR'S PARCEL NUMBER O ' O '024 LOT TRACT
PROPERTY OWNER'S NAME OLv,l�i
ADDRESS �I. 1 Ai, w 1'C-- i 1 Fee CA 17-
PHONk %(j(15-)\/ ]a6 %o EMAIL
APPLICANTNAME
ADDRESS b kilt( 'L UEf CA- I �0
PHONE (gOS-) �Z-041 Zr EMAIL '-e jfl)' C_ •V C U P I
CONTRACTOR'S NAME C, E OWNER BUILDER? ❑YES❑NO
BUSINESS NAME4/4"e /LF13ndfIl C.
ADDRESS rr W 0b0rr c -A c, J 3 -2-0
PHONE( bP5) �,�O�L ^ O�1Lf- G EMAIL C � ,'
CONTRACTOR'S STATE LIC NUMBER C(9 5' /7- LICENSE CLASSIFICATION C'�
VALUATION$ 00 SO,FT L SQ FT -1
APPLICANT'S SIGNATURE DATE 7"2 I
L
DEPARTMENT DISTRIBUTION C� CITYOFME IFEEBUoSI NESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I' SMIP b �/
INVOICE 220 PAIDAMOUNT
AMOUNT OCASH OCHECK JI OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 925860QS1-6��6777
�I�ryY o enlfee
www.cityofinenifee.us Inspection Request Line 951-245-6218uilding & Safety Dept.
JUL 2 9 2017
Received
AMBIENT ELECTRIC INC
To Whom It May Concern:
I Elisha Dan Elder as president of Ambient Electric,Inc.do hereby give my permission for John Ballestero to
obtain business licenses and electrical permits on behalf of Ambient Electric Inc.
P
Elisha D. Elder
President
Ambient Electric,Inc. t
1
Date
�tOO O41.
City Q1` fee
Bull tty�ti@pt.
N�0�vl��` e�
,v J
Reed
2363 TELLER RD, PHONE 818-309-7927
R-nBIEnT UNIT112 FAX 805-262-0425
ELECTRIC NEWBURY PARK EMAIL ambientelectricinc@gmail.com
CA 91320 WEBSI `E ambientelectric.net
LICENSE#995928
SECTION 2 - FLOOR PREPARATION MEW"
Y LW
FOR ALL KIOSK INSTALLATIONS
OPTION 1:
Use the base plate mounting template as a template to align the placement of the anchor
bolts with either the rotating or non-rotating slots.
OPTION 2:
Using an erasable marker, draw an outline of the rotating slots from the base stand cover
onto the floor.
*Please Note: Review electrical section (See Pages 23-29) before proceeding.
CL
Rotating Slots: For installations where the angle of the kiosk may need to be adjusted over time, the O
rotating slots should be used. U
Non-Rotating Slots: For permanent installations where the angle of the kiosk will not need to be W
adjusted over time, the non-rotating slots should be used. U
Using a drill, make four to six holes (total) that correspond to the four to six separate sloLlocations. �
The drilled holes need to conform viith the concrete anchor bolt specifications. ry
Install anchor bolts,per anchor bolt specifications.(Separately Contained In Package Number 1-See Page 1) V/�
Drill 3/8" anchor bolt holes C
Holes should be at least 4"- 5" deep
Use"Anchor Bolt Installation"tools as necessary
:i , Cltlll-EE , ^
FOR POWER + DATA ROUTED Tig0RW*WA;,gTCW DEPARTMENT ,v\
MOUNTING STRUCTURE l N4YIAN APPROVAL
1. Use the base plate mounting template as a drilling template to aely locate tl
tr point into
the kiosk for power and data. PoweVandidataVIIII nded to enter t the V
2. The conduit stubs should not protrude above the finished floor more than 1.5". 1
xial of ttiv:,,plans Ad nol.oe construed to be a permit for,Oran r
approval of,any violation of any provisions of the federal,state or city
regulations and ordinances. This set of approved plans must be kept on the
jobsite until completion.
02016 ZIVELo"1 AU dghtsr rod Instaliatfon Guide I McDonald's EVOLUTION I Version 1.5.3 Page 9
ESECTION.2.-.FLOOR PREPARATION t1 tI tl ELU
�l1ATl 6Jq A25
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61
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i'f OF MENIFEE
BUILDING AND SAFETY DEPARTMENT
PLAN APPROVAL LJ
rr11 1
1V /DATE
'Approval of these plans shall not be construed to be a permit for,&an
approval of,any violation of any provisions of the federal,state or dty
regulations and"ordioances. This set of approved plans'mustlie kept on the
jobsite until completion.
020162JVEL0'I All nghweservad Installation Guide I McDonald's EVOUITION I Version 1.5.3 Page 10