PMT17-03303 City of Menifee Permit No.: PMT17-03303
29714 HAUN RD.
�1VX—EL/-' MENIFEE,CA 92586 Type: Commercial Electrical
""'""" 1`t',— MENIFEE Date Issued:
09/2912017
PERMIT
Site Address: 26329 MALLORY CT, MENIFEE,CA Parcel Number:
Construction Cost: $500.00
Existing Use: Proposed Use:
Description of INSTALL ONE 200 AMP U/G TEMP POWER POLE ON LOT 32 TO PROVIDE POWER TO
Work: PRODUCTION-HIDDEN HILLS TR30142
Owner Contractor
KB HOME S R BRAY LLC
36310 INLAND VALLEY DR 1210 N RED GUM STREET
WILDOMAR, CA 92595 ANAHEIM, CA 92806
Applicant Phone:7145071881
MIKE MCGEE License Number:980589
1210 N RED GUM STREET
ANAHEIM,CA 92806
Fee Description r3ty Amount I$)
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 requidng 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_Pennrt_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 affum under penalty of perjury that 1 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 o 1 am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class I C 10,Cbf ?I License No. 99o5�!p By my signature below I acknowledge that,except for my personal residence
Expires f Signature in which l 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 DECLARAT[0 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 thABusiness 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 wwvv.leeinfo.ca.eov/calaw.htmi.
this permit is issued.
Policy# 7 yo q 51070 l Date
o l 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 carder and policy owner or authorized to act on the property owners behalf.I have read this
number are: ;;77� application and the information I have provided is correct.I agree to comply
Carrier oc(G ins fInSUY'G^s.[-f IXOtce-S with all applicable city and county ordinances and state laws relating to
f building construction.1 authorize representatives of this city or county to
Policyq? y0�/ 307b 1 Expires 3� 7rr7016 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 N
workers compensation laws of California,and agree that if l should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor '
Code,I shall forthwith co ly with those provisions. /� O7 {/ Will the applicant or future building occupant handle hazardous material or
Applicant Date L—Ll�f Lo mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ciYes ciNo
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 forguidelines
CONSTRUCTION LENDING AGENCY ciYes ❑No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1D00 feet ofthe
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) O Yes ❑No
OWNER BUILDER DECLARATIONS 1 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
Contactors License Law for the reason(s)indicated below by the California Health al Safely Code,Section 25505 and 25534 concerning
hazardous material reporting.
cfieckmark(s)I have placed next to the applicable item(s)(Section 7031.5 OVes ❑No
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 rile a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING MRP)
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-certifled 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
O I,as owner of the property,or my employee with wages as their sale 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.aov/lead or contact the National Lead Information Center at
not intended a 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 O 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:
❑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 & SAFETY PERMIT/PLAN CHECK APPLICATION
. Menitee
DATE: 1"'70'/ PERMIT/PLAN CHECK NUMBER to O
TYPE: frCUMMERCIAL 0 RESIDENTIAL Q MULTI-FAMILY O MOBILE HOME <:% POOL/SPA "SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION et-LECTRICAL C} MECHANICAL
, NEW o PLUMBING ORE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK /NfI;NA- ONE Zsv 04 oN 4.o
3 70 AlAr #VoA< -r? Axowrlwo.
PROJECT ADDRESS z.,3ZQ ZIP Z
ASSESSOR'S PARCEL/N /UMBER LOT 3 Z TRACT o dZ
OWNER NAME j' hVwC
ADDRESS Iac, .-b ''9'46 �(I, Lr7r
PHONE (f/rz EMAIL
APPLICANT NAME 11 1jee _g5
ADDRESS
PHONE Sf/Zl7-/7J 3 / EMAIL /+,IAZA ge/64.&., 44-r. Cw/ti
CONTRACTOR'S NAME OWNER BUILDER? O YES t"N6
BUSINESS NAME
ADDRESS /Z/o N. werb ArA %.14 AmJlfiffVA CA 9ZAD
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER lofte LICENSE CLASSIFICATION a eo
VALUATION$ .5�0 -- SO FT L SO FT
APPLICANT'S SIGNATURE �- - DATE °I-Z.O-/
CITYSTAFF USEONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: t`�`/)
t �\ CITY OF MENI EE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
PERMIT FEE �•O'J SMIP GREEN
PLAN CHECK FEE I INVOICE TOTAL
OWNER BUILDER VERIFIED 0 YES 0 NO DRIVERS LICENSE# NOTARIZED LETTER 0 YES O NO
Citynt-Menitee
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