PMT17-03973 City of Menifee Permit No.: PMT17-03973
29714 HAUN RD.
{!>CCEL/-> MENIFEE, CA 92586 Type: Commercial Electrical
MENIFEE Date Issued:
11109/2017
PERMIT
Site Address: 29296 ROCKPORT RD,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: TR 37161
Owner Contractor
PULTE HOMES S R BRAY LLC
27101 PUERTA REAL STE 300 1210 N RED GUM STREET
ANAHEIM, CA 92806
Applicant Phone:7145071881
MENIFEE,CA License Number:980589
Phone: 9512931333
Fee Description sty Amount ISI
Services, Switchboards, Control Centers&Panels 1 183.00
Building Permit Issuance 1 27.00
Additional Plan Review Building 74 74.18
GREEN FEE 1 1.00
General Plan Maintenance Fee-Electrical 1 9.15
$294.33
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_Pennit_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 a I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. G, the following reason:
License Class C/o License No. -1dD `1 By my signature below l acknowledge that,except for my personal residence
Expires 7/2/v Signature in which I must have resided for at least one year priorto completion of
improvements covered bythis 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
a 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
this permit is issued. www.leginfo.ca.gov/mlaw.htmi.
Policy g Date
NThave 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 a 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 1 have provided is correct.I agree to comply
Carrier}��OPACAY '! r/U./IVMGE GFfr''`/ with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy gCU!;N'fi3*?a7— Expires 3/11AF 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 emoloy any persons in any mannerso as to become subject to the CITY BUSINESS LICENSE 11 03 51M
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 /�/��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 ❑Yes ei45
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($10D,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Aft Quality Management District(SCtionor See permitting from
checklist
IN SECTION 3706 OFTHE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Airlines
Qua
CONSTRUCTION LENDING AGENCY aYes efNo
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 sa'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 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 reports .
Business and Professions Code).Any city or county that requires a permit to ay'u o Noconstruc
^� Date_ o
issuance also requires h applicshorre hepermiany tructue a signets 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(RRP)
License Law(Chapter9(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
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.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. a No EPA Lead-Safe Certified Firm is required for this project because:
O 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 rill out the RRP
Acknowledgement.
�v'lei^liTe
DATE: 11/3/17 PERMIT/PLAN CHECK NUMBER �r O '1117
TYPE: C✓COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOUSPA OSIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION &<ECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK Install one 200amp U/G temporary power pole for construction use
at Pulte's "Reflections" project, tract#37161.
PROJECTADDRESS ZIP
ASSESSOR'S PARCEL NUMBER LOT TRACT#37161
OWNER NAME PULTE HOMES
ADDRESS 27101 PUERTA REAL STE. #300, MISSION VIEJO, CA 92691
PHONE 949-623-3700 EMAIL
APPLICANTNAME Mike McGee
ADDRESS
PHONE 951-293-1333 EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES 816
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 SQFT L So.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 SMIP GREEN
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES 0 JNO
Dept
City of blenifee Building&Safety Deparment289977114 t�oewn RY'Menifee, CA 92586 951-672-67 kV Dept.wwlv.Cital rufJ .[Uv
Received Received
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