PMT17-03873 City of Menifee Permit No.: PMT17-03873
29714 HAUN RD. T Commercial Electrical
<ACCELA� MENIFEE, CA 92586 Type:
MENIFEE Date Issued: 1 110 312 01 7
PERMIT
Site Address: 27582 LA PIEDRA RD, MENIFEE, CA Parcel Number:
92584 Construction Cost: $500.00
Existing Use: Proposed Use:
Description of INSTALL(1)200 AMP U/G TEMP POWER POLE FOR FUTURE PRODUCTION NEEDS.
Work: TR 37179 DA-4 CLUSTER
Owner Contractor
LENNAR HOMES S R BRAY LLC
980 MONTECITO DRIVE SUITE 300 1210 N RED GUM STREET
CORONA,CA 92879 ANAHEIM, CA 92806
Applicant Phone:7145071881
MIKE MCGEE License Number.980589
1210 N RED GUM STREET
ANAHEIM, CA 92806
Phone: 9512931333
Fee Description O_yt Amount(SI
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 building operations being carded 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
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 O I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full form and effect GGw�s Dq the following reason:
license Class C/o License No. aV V r By my signature below I acknowledge that except for my personal residence
Expires 71 �Q 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
O I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that 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.Roy/calawintmi.permit is issued.
Policy N Date
of have and will maintain workers compensa Gon insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which D 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
numberare: application and the information I have provided is correct.I agree to comply
x4rAMR6'% JNf�I/h�GE G�1r�Y 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 gC(...1.711M 070Z Expires 3/11//g 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 AUTHOR17ED AGENT
D I certify that in the performance of the work for which this permit is issued,
IshallnotemoloV any persons in any manner so as to become subject to the CITY BUSINESS LICENSE If
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 forthwith comply wit visions. Will the applicant or future building occupant handle hazardous material or
Applicant Date ��1�/-J 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 IS oYes z Nb
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(SCAQM D)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY oYes srNo
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 &r1go
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that 1 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
hazardous material reporti
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 des o No 1 c3
Business and Professions Code).Any city or county that requires a permit to Date g��y17
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNEROR 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(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Cade)or that he or she is exempt from[!censure 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 arthrough their
o 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 forsale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a DAn 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 forthis 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
Men'fee
DATE: PERMIT/PLAN CHECKNUMBERPM
TYPE: COMMERCIAL O RESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: 0 ADDITION 0 ALTERATION O DEMOLITION LECTRICAL O MECHANICAL
O NEW O PLUMBING 0 RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK IN u_ &%�E Zcn V dLA,e Po4F# f
I'AW,rhr l dS ,rrZewjA&
Q-r 4f,3 -?T - 6u�t�
PROJECTADDRESS 27�0^Z 'Q^'- / teDA?,4 ;Faill.0 ZIP
ASSESSOR'S PARCEL NUMBER 3(a O.8 SD• b 4/ LOT TRACT 7/71
OWNER NAME
ADDRESS 9P /t&VIFr-M S_Mlt Jao C6 GR 9Z877
PHONE 93_j- fP-3SdD EMAIL
APPLICANTNAME A1114-_ A ct
ADDRESS
PHONE 95/- 417-7_ 733 EMAIL M/!«h IS-PD Z,*T.
CONTRACTOR'S NAME /// p OWNER BUILDER? 0 YES (k<OO
BUSINESSNAME S.,e, Q/11Iy PLC dyr Pd u
ADDRESS I o N. D eA-, -r ,-,~I 'I'zP(o
PHONE 9}'/� ')- /�,13 EMAIL
CONTRACTOR'S STATE LIC NUMBER IIP5?7 LICENSE CLASSIFICATION L'{O
VALUATION$ 56D — SOFT L SQ FT
APPLICANT'S SIGNATURE DATE Z.b`I7
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF ME EE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY:
PERMIT FEE SMIP GREEN
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDERVERIFIED OYES 0 NO DRIVERS LICENSE# NOTARRED LETTER 0 YES C NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-ST1' Dept.
www.cityofinenifee.us OCT 2 7 2017
Received
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