PMT17-03521 City of Menifee Permit No.: PMT17-03521
29714 HAUN RD.
4!NC EL/-> MENIFEE, CA 92586 Type: Commercial Electrical
MENIFEE Date Issued: 10/16/2017
PERMIT
Site Address: 29173 NEWPORT RD, MENIFEE, CA Parcel Number:
92584 Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of INSTALL ONE 200A U/G TEMP POWER POLE, ONE 100A AND ONE 50A SUB-POLE FOR
Work: CONSTRUCTION TRAILER AND PRODUCTION
Owner Contractor
CVS S R BRAY LLC
USS SLATON LLC C/O PACIFIC RETAIL PARTNE 1210 N RED GUM STREET
1949 ARROYO DRIVE ANAHEIM, CA 92806
Applicant Phone:7145071881
MIKE MCGEE License Number:980589
S R BRAY LLC
1210 N RED GUM STREET
ANAHEIM, CA 92806
Fee Description gyt Amount 1$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
$368.62
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_Permit_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 r� License No. By my signature below I acknowledge that,except for my personal residence
Expires 34(14.17 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 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.ca.gov/calaw.htmL
this permit is is
Date
Policy
PROPERTY OWNER OR AUTHORIZED AGENT
�klTave and will maintain workers compensation insurance,as required by
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 polity 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
-p with all applicable city and county ordinances and state laws relating to
Carrier �( building construction.I authorize representatives of this city or county to
Policy ff AC �9-7 / 2Expires 9131��� enter[he 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 emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE 0
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation prop 'skins of Section 3700 of the Labor
Code,I shall forthwith comply vi Ze provisions. Will the applicant or future building occupant handle hazardous material ora
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO C E WORKER'S COMPENSATION COVERAGE IS ❑Yes FiNo
UNLAWFUL,AND SHA BJECT 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 ❑Yes No
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) ❑Yes .No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exemptfrom the permitting checklist.I understand my requirements under the State of
California Health&Safety Code,Section 25505 and 25534 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 No
Business and Professions Code).Any city or county that requires a permit to Date/D
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWN THORIZED 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 RENO1 ON.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
❑1,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.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).
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:
❑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.
(f4.
SAFETYBUILDING & PERMIT/PLAN APPLICATION I
t �
Menifee
Ad�wkl_
DATE: PERMIT/PLAN CHECK NUMBER
TYPE: %"COMMERCIAL 0 RESIDENTIAL O MULTI-FAMILY 0 MOBILE HOME C) POOL/SPA :}SIGN
SUBTYPE: 0 ADDITION -ALTERATION 0 DEMOLITION �CTRICAL 0 MECHANICAL
C NEW O PLUMBING ,C RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK ZOD G % fie ,E
ovc ZA" u-tug inz G . � i/�M 2*75k �I Ot M ttee t.
QQ Y P
PROJECT ADDRESS �CYS .iD)PEtf- ;'E atj Z(�Z�ZIP
V Z01T
ASSESSOR'S PARCEL NUMBER // LOT TRACT
OWNERNAME USf S AJ [LC -f Received
ADDRESS
PHONE __ EMAIL
APPLICANT NAME /tt ,�& Ac-
ADDRESS
PHONE ��I" Zi°�,? - /737 EMAIL 110C Lt.[� tvf�: ,
CONTRACTOR'S NAME // OWNER BUILDER? 0 YES 1%116
BUSINESS NAME
ADDRESS fj' NR' Sb
PHONE pEMAIL
CONTRACTOR'S STATE LIC NUMBER /aW / LICENSE CLASSIFICATION CGO
VALUATION$ I sJD SO FT L SQ FT
APPLICANT'S SIGNATURE - DATE
CITYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I
ACCEPTED BY:
PERMIT FEE ��^�, SMIP X GREEN 1—
r
CHECK FEE INVOICETOTAL '� o, �SBUILDER VERIFIED OYES 0 NO DRIVERS LICENSE IT NOTARIZED LETTER C) YES p NO
City of Ivlenifee Building&Safety Department 29714 Houn Rd. Nienifee, CA 92586 951-672-6777
www.cityofinenifee.us
City of Menifee
Building& Safety Dept.
OCT 0 3 2017
NELJMT
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REVIEWED BY
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STANDARD—, D 'I
"Approval of these plans shall not be construed to be a permit for,or an
_ approval of,any violation of any provisions of the federal,state or city
ulations and ordinances. This set of approved plans mys4teepta °r10 \
_--' D sit until co letion.
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