PMT17-03874 City of Menifee Permit No.: PMT17-03874
29714 HAUN RD.
<A-CCEL/-> MENIFEE, CA 92586 Type: Commercial Electrical
MENIFEE Date Issued:
11/03/2017
PERMIT
Site Address: 27620 PARK PLAZA 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 gyt Amount IS)
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 requiring the correction of errors in the plans and
specifications or from preventing builiding 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_Pernit_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).
1 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. Gsr the following reason:
License Gass c/o License No.
By my signature below I acknowledge that,except for my personal residence
Expires 3/ ' Signature in which l must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
have built as an owner-builder if it has not been constNcted 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
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.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy If Date
cKhave and will maintain workers compensajion 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
number are: application and the information I have provided is correct.I agree to comply
Carrierx�04CA6.51� T'VJf14 Z G/r4l' with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#CLW 7//4336� 7— Expires 3/30w 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
o i certify that in the performance of the work for which this permit is issued, 7
1 shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
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
mixture containing a hazardous material equal to or greater that the
Applicant Date �y/�7 amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes eimb
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 modi8ratian 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 DYes efNo
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) D yes "0
OWNER BUILDER DECLARATIONS I 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
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material report. g.
Business and Professions Code).Any city or county that requires a permit to D No
�--�� Date 0!
construct,alter,Improve,demolish or repair any structure,prior to its PROPEROWNER—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 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
than($500). q P p p he owners and property
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 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 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. D No EPA Lead-Safe Certified Firm is required for this project bemuse:
01,as owner of the property am exclusively contracting with licensed
contrectors to construct the project(Sec ion.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 PERMIT/PLAN
• • APPLICATION
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wwenifee
DATE: PERMIT/PLAN CHECK NUMBER Pmr1-1
TYPE: COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION LECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK s u. aA+G Zao 7 A,.AC o hoylr
PROJECTADDRESS Z7rc ZO r42/c /e*Z - /gPr/ ZIP
ASSESSOR'S PARCEL NUMBER 3 ,o - 650 -017 LOT TRACT 37171
OWNER NAME
ADDRESS 990 / awa m7b 4e, Singjao Ga GR 92�
PHONE '?V- f17-3S4D EMAIL
APPLICANT NAME �7(I.IE MG
ADDRESS
PHONE pis/- ZS7-/.133 EMAIL //►
CONTRACTOR'S NAME OWNER BUILDER? O YES rktrO
BUSINESS NAME S. ,
ADDRESS I /o N. &b h NRAofn cA IZAP
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER 101bal LICENSE CLASSIFICATION c'fJ
VALUATION$ SLb — SO FT L SO FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION
ACCEPTED BY: CITY OF MENIFEE BU INESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
PERMIT FEE aao,`s SMIP GREEN
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee
9uilditLa De.�
City of Menifee Building&Safety Department 2971k Houn Rd. Menifee, CA 92586951-Iffef7f271 2017
www.cityofmenifee.us
NOV '0 2 M7
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