PMT17-04012 City of Menifee Permit No.: PMT17-04012
29714 HAUN RD.
�-1-lCCEt_A? MENIFEE,CA 92586 Type: Commercial Alteration
MENIFEE Date Issued: 1111412017
PERMIT
Site Address: 27159 NEWPORT RD, MENIFEE, CA Parcel Number: 360-050-025
92584 Construction Cost: $1,000.00
Existing Use: Proposed Use:
Description of TEMP EVENT CHRISTMAS TREE LOT FOR VALLEY VIEW TREES W/60'X 90' CANOPY,
Work: TEMPORARY POWER POLE
Owner Contractor
MICHAEL CLEARY VALLEY VIEW TREES LLC
30746 EARLY ROUND DR 1574 COBURG RD#1175
CANYON LAKE,CA 92587 EUGENE,OR 97401
Applicant Phone:5419530293
MEL COOPER License Number: 17-PEOP-00032
VALLEY VIEW TREES LLC
1574 COBURG RD#1175
EUGENE, CA 97401
Phone:5419530293
Fee Description ON Amount($)
Temporary Power Pole 1 67.00
Building Permit Issuance 1 27.00
Inspections not specked 129 129.07
Additional Plan Review Building 129 129.07
GREEN FEE 1 1.00
SMIP COMMERCIAL 1 1.00
$354.14
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_Bidg_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 contractors)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from Iicensure under the Contractor's State License Law for
.Professions Code and my license is in full force and effect. the following reason:
License Class License No.
By my signature below I acknowledge that,except for my personal residence
Expires Signature in which 1 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 constructed in its entirety by
❑1 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 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 whichv.ieeinfa.ra.zov/calaw.html.
this permit is issued.
\Poolicy# Date
ldI have and will maintain worker's 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:1 am the property
this permit is issued.My worker's compensation Insurance carrier and policy rowner or authorized to act on the property owner's behalf.I have read this
number are: --{/ i '/X`,, application and the information I have provided is correct.I agree to comply
Carrier / `�/"'�"�Sti 1 `y�..,Ll'`S(q✓Gri2L I-G�I with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#�/�/!J �/ Expires 7 enter the above tde jfied property for inspection purposes.
°
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less Date
PROPE OWNERO UTHORIZED 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#
worker's compensation laws of California,and agree that If I should becomeI,w�wRDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the labor VT"'"'"'�
Code,I shall forthwitlTco pl jth those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date I
mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Ma ,tals InFoP.�ide7
WARNING:FAILURE TO SE[U � WORKER'S COMPENSATION COVERa EIS D Yes vivo llyy tit Dept,
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES / building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN Will the intended use of the building by t applicant or future building
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the constructions or mid caypg7ram South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(5 a e`�ae n checklist
forgul4ellneS
CONSTRUCTION LENDING AGENCY ❑Yes "a E
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modifie a iv �fe
lending agency for the performance of the work which this permit is issued oute oundary of a school? �j V
(Section 3097 Civil Code) ❑Yes Po
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
Contractor's 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 rep rti
Business and Professions Code).Any city or county that requires a permit to Yes ❑No d 7
construct,alter,Improve,demolish or repair any structure,prior to its Date /
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNEft OR Au0bRIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRPI
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 Iicensure 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 disturbs
paint
and comply with
than
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
01,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( I portion of the work,and the structure Is www.eoa.¢ov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80D-424-LEAD(5323).
Code;The Contractor's 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'ar personal effort,builds or Improves the P P J
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 Contractor's 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 RAP
Acknowledgement.
BUIL DING & SAFETY PERMIT/PLAN CHECK A P PLICATION
\1a6� (t wo s� Menifee
DATE: -�7 PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY C> MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK AyN p (/ /X I
zt-,A,
PROJECT ADDRESS A/6v✓ C41P /
ASSESSOR'S PARCEL NUMBER 3 v �1S TRACT
OWNER NAME /C/ e ✓
ADDRESS (� Bl/ GLL 1"�y�2 '-�G!/�I. G� 1 %.0 ,
PHONE EMAIL
APPLICANT NAME I ,r L L
ADDRESS LL ✓ I� /J
PHONE S�/ �' 3 EMAIL ��(�eWSZ )11 ,-�
CONTRACTOR'S NAME OWNER BUILDER? O YES O NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION /�� / . CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY: ��U/'v/
PERMIT FEE 1CAM SMIP GREEN
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE N NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 HGLIn Rd. Menifee, CA 92585 951-672-6777
ovww.cityofinenifee.us
Riverside County Fire Department Office of the Fire Marshal
Riverside Office: Palm Desert Office:
2300 Market Street,Ste. 150 77-933 al s i onfanas Rd.,Ste 201
Riverside,CA 92501 Palm Desert CA 92211
Phone: (951) 955-4777- Fax: (951) 955-4886 Phone: (760) 863-8886-Fax: (760)863-7072
Office Use Only
SPECIAL EVENT PERMIT r =tyof Riverside F&F
Fire De®t
FD Permit # I -TOE- 5EP 2 4 2017
County/CityPermit# RECEIVED
Plans Received
EVENT INFORMATION
Event Name: F P 1-CW �e a LLCi Event Contact: iL4��(. ,rol
Address: 7`7J2. po" Phone: p
City/ Zip: f e-r' CA ai5731 Type of Event: CiS yiJ I7ru. .Q ef.
Event Date(s): !S /7 Time Start: �� Time End: t�0/'M Total # of people: lava
Additional Notes: A/ Sdw e, lim.e laws j Tic• )'Yv
APPLICANT,/SSPONSO��RRI/I,, /NG ORGANIZATION INFORMATIO,N,/�
Company Name: >> la v ' ' f Applicant Name: 1e,
Address: I-r7 91 z�I r�/ S Phone: S �� O;-g13
City/ Zip: nci o/ 1 �]7�� Email: MC:a&i}�
Mark all that appal.
Food S Beverage:
❑ Catered On-site/off-site ❑ Barbeques/ Grills ❑ Deep Fryers ❑ Ranges ❑ Woks
Tents/Canopies:
Tents over 400 square feet: Canopies over 700 square feet:
Copy of fire retardant certification providedYes ❑ No
Booths: Number of booths: Cooking: ❑ Yes ❑ No
Generators: Quantity: Refuel Required ❑ Yes ❑ No
Open Flame/ Pyro: ❑ Yes ❑ No *Form 21 -Special Effects may be required
OFFICE USE ONLY
Fee Paid: Permit Review Standby/ Safety Inspection
❑Approved ❑ Denied Required: ❑ Yes ❑ No
Date Paid:
Reviewed by: Person Assigned:
Check#:
Received By: Date: Final Approval: ❑Granted ❑Denied
Receipt#(OCR) Sign: Date:
❑DBF ❑DBF ❑DBF
Fom 20—Revised 6/20/17 Visit us at www.rvcfire.ora
City of Menifee
Building Dept.
CGTY OO F M E H FEE NOV i 4 2017
Planning Division Received
CASE NUMBER 2,pt7-3 1 '2 T1 0 c.-
Riverside County Fire Department— Planning and Engineering ❑ Comment
❑ No comment
REVIEWED BY SOt-jYr'\ `P u DATE tO " h
COMMENTS:
' Sf c PnTAUtElD n>J b Ct10 r'S
AP PQ bVE-D A P P-E'V t0A Y15A17-
CD
PROVAL '
Riversid Cou L , ir_ apartment
Offic o he it I rsha!
By: _ __ O•
Sony u
The approval of ans and s ations does not
permit the violation,deleti:m,omission or faulb/
is st.cation of any requirements of Title 29 er any
Loral Ordinances.Construction shall remain
accessible and exposed for inspection purposes until
approved by the Fire Department.
City of Menifee Land Use Development Application
Page 4 of 6
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