PMT18-01381 City of Menifee Permit No.: PMT18-01381
29714 HAUN RD.
MENIFEE, CA 92586 Type: Commercial Electrical
MENIFEE MENIFEE Date Issued: 09/11/2018
PERMIT
Site Address: 30232 CAREY RD, MENIFEE,CA Parcel Number:
Construction Cost: $500.00
Existing Use: Proposed Use:
Description of INSTALL(1)200AMP UNDERGROUND TEMPORARY POWER POLE FOR FUTURE CONSTRUCTION
Work: TRAILER AND PRODUCTION AT RSI"CAMDEN PLACE"PROJECT.
LOT 44
CAMDEN PLACE-TR37067
Owner Contractor
RSI COMMUNITIES S R BRAY LLC
620 NEWPORT CENTER DRIVE 1210 N RED GUM STREET
12TH FLOOR ANAHEIM, CA 92806
Applicant Phone:7145071881
S R BRAY LLC License Number: 980589
1210 N RED GUM STREET
ANAHEIM, CA 92806
Phone:7145071881
Fee Description Qtv Amount(EI
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_Bidg_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
1 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 a I am exempt from Iicensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class C10 License No. 9�'8 By my signature below l acknowledge that,except for nrypersonal residence
Expires 31 inwhich lmusthave resided for at least one year priorto completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legallysell a structure that I
have built as an owner-builder if it has not been constructed in Its entirety by
o I hereby affirm under penalty of perjury one of the following declarations:) 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 webske:
by Section 3700 of the Labor Code,for the performance of work for which www.IeglnFc,.ca.f!av/caIaw.htmI.permit is issued.
Policy If Date
o'fhave and will maintain workers cgmpensaton insurance,as required by
PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which o By my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
yUQ�r � r/Uf �� G� with all applicable city and county ordinances and state laws relating to
Carrier/` L building construction.I authorize representatives of this city or county to
Polity BC�ir 7f"a3670Z Expires 31309 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($10D)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑Icertify that in the performance of the work for which this permit is issued, �3 �YZ�Ishallnotemolov 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 � wfA ions. 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 DYes c Wb
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($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY Dyes erNo
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) o Yes ago
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that 1 am exempt from the permitting checklist.I understand my requirements underthe State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item hazardous material reports g.$)(section 7031.5 � o No OO/
Business and Professions Code).Any city or county that requires a permit to s -No Date
construct alter,improve,demolish or repair any structure,prior to its PROPERTY OWN—E—R Olt 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(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 Seaton 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 properly owners and property
than($SOOJ. managers who do the paint-disturbing work themselves or through their
01,as owner of the property,or my employee with wages as their sale 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 1-800424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of 0An 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. o No EPA Lead-Safe Certified Firm is required-forthis pmjea 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 fill out the RRP
Acknowledgement.
Ivilarli f6-'
DATE: PERMIT/PLAN CHECK NUMBER I I�
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING 0 RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK Install one 200amp U/G temporary power pole for future construction
trailer and productions at RSII''/s" "Camden Place" project, tract#37067. 1 Lvt- $'
PROJECTADDRESS $b23 carw ea ZIP
ASSESSOR'S PARCEL NUMBER V LOT TRACT#37067
OWNER NAME RSI COMMUNITIES
ADDRESS 620 NEWPORT CENTER DR 12th FL, NEWPORT BEACH, CA 92660
PHONE 949-270-3628 EMAIL MIKEM@POWERPLUS.COM
APPLICANT NAME Mike McGee
ADDRESS
PHONE 951-293-1333 EMAIL MIKEM@POWERPLUS.COM
CONTRACTOR'S NAME OWNER BUILDER? O YES CNO
BUSINESS NAME S.R. Bray LLC, dba PowerPlus
ADDRESS 1210 N. Red Gum St,Anaheim, CA 92806
PHONE 714-765-7551 EMAIL
CONTRACTOR'S STATE LIC NUMBER 980589 LICENSE CLASSIFICATION C10
VALUATION$ 500.00 SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE 3 '27-/J
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY:
PERMIT FEE 2ZO- �_ SMIP tt I GREEN 141
PLAN CHECK FEE INVOICETOTAL
OWNER BUILDERVERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92589My-afAAEnlfee
www.cityofinenifee.us Building Dept.
MAR 2 7 2018
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