PMT17-04416 City of Menifee Permit No.: PMT17-04416
_ 29714 HAUN RD.
�CCEL/-> MENIFEE, CA 92586 Type: Sign-Permanent
MENIFEE Date Issued: 12/13/2017
PERMIT
Site Address: 28120 BRADLEY RD, MENIFEE,CA Parcel Number: 337-301-017
92586 Construction Cost: $8,300.00
Existing Use: Proposed Use:
Description of INSTALL OF 3 SETS OF LED INTERNALLY ILLUMINATED CHANNEL LETTER SIGNS
Work:
Owner Contractor
RANDY JACOBS, MD SOCAL ELECTRIC
28120 BRADLEY RD 9144 PARADISE PARK DR
MENIFEE, CA 92586 LAKESIDE,CA 92040
Applicant Phone:6195611701
CHAD ADDINGTON License Number.738312
SOCAL ELECTRIC
9144 PARADISE PARK DR
LAKESIDE, CA 92040
Fee Description 2 rr Amount(S)
Sign Permit 3 190.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 9.50
$227.50
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_Permit_Template.rpt Page 1 of 1
i
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).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and AI am exempt from licensure under the Contractors State License Law for
Professions Code m license is in full force and effect. the following reason: 46 aq)4C.-5
License Class LicensI o By my signature below I acknowledge that,except for my personal residence
Expires 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 DECLARATIONhave built as an owner-builder if it has not been constructed in its entirety by
❑I hereby affirm under penalty of perjury one clarations: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 i mitt or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which www.le info Av .h
this permit is issued. 1
Policy If G t <Date
❑1 have and will maintain workers compensation Insurance,as required by PROPE&OWNER OR D AGENT
section 3700 of the Labor Code,for the performance of the work for which iaay my signature,Ibdow 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
with all applicable city and county ordinances and state laws relating to
Carder building construction.I authoriz}representatives of this city or county to
Policy If Expires enter the ab '("dery"fed pr ¢arty for inspection purposes.
(This section need not to be completed is the permit is for one-hundred ` `/ Date
dollars($100)or less PROPERfY OWNER OR HORIZED AGENT
Al certify that in the performance of the work for which this permit is issued,
I shall not emoiov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# (5(4EJ
workers compensation jaws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worke c Jpenon provisions of5ection 3700 of the Labor
Code,I shall fort those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date al) mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SE WORKER'S COMPENSATION COVERAGE IS o Yes (�No
UNLAWFUL,AND SHALL JECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP T NE 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 forguideli es
CONSTRUCTION LENDING AGENCY 0Yes lo
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) ❑Yes f No
OWNER BUILDER DECLARATIONS I have related the Hazardous Material Information Guide and the SCAQMD
1 hereby affirm under penalty of perjurythat I am exempt from the permitting checklist.I and rstand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health& cafe C de,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 h ardous mate' I r /
Business and Professions Code).Any city or county that requires a permit to s D No / 7
construct,alter,improve,demolish or repair any structure,prior to its Date
PROPERTYWNE
issuance,also requires the applicant for the permit to file a signed statement AUTHORIZED AGENT
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 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
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( )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. �(Ncf o EP ead-Safe Ce �fied Firm is required forthis project because:
o I,as owner of the property am exclusively contracting with licensed '` � 'U
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 RAP rule please fill out the RRP
Acknowledgement
BUILDING & SAFETY PERMIT/.PERMIT/PLAN CHECK • . . •
Menifee
.90-ft-,&_0
DATE: PERMIT/PLAN CHECK NUMBER — O L
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL,/SPA SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION KELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES tt
DESCRIPTION OF WORK O V % ri j vyj 111Cl'1
PROJECTADDRESS !dQ C> Cpcmgy 3cocl ZIP a
ASSESSOR'S PARCEL NUMBER 3/37mLb 7LO 3 TRACT j
OWNER NAME Roma,
ADDRESS e
PHONE gS�,G .y5�5 EMAIL
APPLICANT NAME "
ADDRESS "7 m
PHONE !3 EQ , S(,O, ;k7 EMAIL G
CONTRACTOR'S NAME `Y OWNER BUILDER? O YES Q*O
BUSINESS NAME (2C_ C
ADDRESS c C _a o
PHONE 619, S(pj, k7" ) EMAIL ,Cp
CONTRACTOR'S STATE LIC NUMBER O3 L'�. q LICENSE CLASSIFICATION C
VALUATION$ aa¢" SO FT /i Corn jntr) L SQ FT
G ) [
APPLICANT'S SIGNATURE DATE I a/ I�/ aO � -7
CITYSTAFF USE ONLY I
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE ACCEPTED
�,,/�
PERMITFEE629-7 SMIP GREEN `
PLAN CHECKFEE INVOICETOTAL a ', S
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us