PMT17-03972 City of Menifee Permit No.: PMT17-03972
29714 HAUN RD. Type: Commercial Electrical
'C�KCCELA? MENIFEE,CA 92586
MENIFEE Date Issued:
11/09/2017
PERMIT
Site Address: 24327 PONDEROSA LN,MENIFEE, CA Parcel Number:
92584 Construction Cost: $500.00
Existing Use: Proposed Use:
Description of INSTALL(1)200AMP U/G TEMP POWER POLE FOR CONSTRUCTION USE
Work: TR31392
Owner Contractor
BROOKFIELD HOMES S R BRAY LLC
3090 BRISTOL ST STE 200 1210 N RED GUM STREET
MENIFEE, CA 92626 ANAHEIM,CA 92806
Applicant Phone:7145071881
MENIFEE, CA License Number.980589
Phone:9512931333
Fee Description QtV Amount(b)
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 building operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise 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_Pennit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
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 Contractor's State License Law for
Professions Code and my license is in full force and effect. Gw the following reason:
License Class C10 License No. 47q By my signature below l acknowledge that,except for my personal residence
Expires �� inwhich l musthave resided for at least one year priorto completion of
improvements covered by this permit.I cannot legallysell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
cz 1 hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.)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 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.Ieginfo.ca.eov/caIaw.htmI.permit is issued.
Policy# Date
g(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 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
K�JP�Ci/}Gs-�% 1NJLl�h,1f�. Cr/�4Wf 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#CL.Y'71273 67o 7— Expires 3/3 J//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 AUTHORIZED AGENT
D 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#
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 witJLlhos visions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date /�/�7 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 0 Yes Q-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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY OYES AO
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 2-90
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that l 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 reporti g.
Business and Professions Code).Any city or county that requires a permit tos o N—o_
Date U
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 file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires wntractors
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 fora 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 orthrough 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.zov/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 because:
01,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.
r_,✓
DATE: 1 1/3/17 PERMIT/PLAN CHECK NUMBER Twil Q
TYPE: 8'COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA c SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION &ILECTRICAL O MECHANICAL
O NEW O PLUMBING 0 RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK Install one 200amp U/G temporary power pole for construction use
at Brookfiield's tract#31392.
PROJECTADDRESS Z'Y-3Z 1 R6wr,`II5"54- L,c/• ZIP
ASSESSOR'S PARCEL NUMBER LOT 87 TRACT#31392
OWNER NAME Brookfield Homes
ADDRESS 3090 Bristol St Ste 200, Costa Mesa, CA 92626
PHONE (858) 481-8500 EMAIL mikem@powerplus.com
APPLICANT NAME Mike McGee
ADDRESS
PHONE 951-293-1333 EMAIL mikem@powerplus.com
CONTRACTOR'S NAME OWNER BUILDER? O YES �<O
BUSINESS NAME S.R. Bray LLC, dba PowerPlus
ADDRESS 1210 N. Red Gum St,Anaheim, CA 92806
PHONE 714-765-7551 EMAIL
CONTRACTOR'S STATE LIC NUMBER 980589 LICENSE CLASSIFICATION C10
VALUATION$ 500.00 SO FT L SQ FT
APPLICANT'S SIGNATURE —✓ DATE 11/3/17
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
PERMIT FEE d"O`�• 1� SMIP GREEN
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED OYES 0 NO DRIVERS LICENSE iI NOTARIZED LETTER 0 YES 0 NO
city of
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City of Menifee
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