PMT18-01950 City of Menifee Permit No.: PMT18-01950
29714 HAUN RD.
�CCELA? MENIFEE,CA.92586 Type: Commercial Electrical
MENIFEE Date Issued: 05/16/2018
PERMIT
Site Address: 24644 BIG COUNTRY DR, MENIFEE,CA Parcel Number:
92584 Construction Cost: $2,500.00
Existing Use: Proposed Use:
Description of INSTALL U/G TEMP POWER METER 200AMP FOR PRODUCTION AT TR 36485-3 TRIBUTE
Work:
Owner Contractor
D R HORTON S R BRAY LLC
2280 WARDLOW CIR#100 1210 N RED GUM STREET
CORONA, CA 92880 ANAHEIM,CA 92806
Applicant Phone:7145071881
VIC LUNA License Number.980589
1210 N RED GUM STREET
ANAHEIM,CA 92806
Phone:9512595656
Fee Description ON Amount ISI
Services, Switchboards,Control Centers&Panels 1 183.00
Building Permit Issuance 1 27.00
Administrative Fee 74 74.18
Additional Plan Review Electrical 1 1.00
GREEN FEE 1 1.00
$286.18
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.rpl 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 perjurythat 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 ❑I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the fallowing reason:
License Class 1J,C I O '9"?f Lice a No. I g6< see By my signature below I acknowledge that,except for my personal residence
Expires 2 Signature dJe±: 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 DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
❑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/calaw.html.
Policy N Date
❑I 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 carder 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
Carrier D C Cf L/C, with all applicable city and county ordinances and state laws relating to
AA //'� building construction.I authorize representatives of this city or county to
Policy q Fi/GG�37z/ S/7� xpires 34:71 l f 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
o l 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 p
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the wor rs compensation provisions of Section 3700 of the Labor
Code,I shall fo i It comply Ifh those provisions. Will the applicant or future building orb nt handle hazardous material or a
w mixture containing a hazardous Sal at to or greater that the
Applicant Dale / amounts specified on the Haza s enals II oormation Guide?
WARNING:FAILURE T SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use oftle ding by t�i41a plicantor uilding
AND CIVIL FINES UP TO ONE HUNDREDTHOUSAND DOLLARS($100,000),IN occupant require a permit for the c ruction o'r''` n from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management DI (SCAQM ermitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY oyes ❑No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modif Ity 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 Cade) ❑Yes ❑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
California Health al Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the
hazardous material reporting.
checkmark(5)1 have placed next to the applicable Rem(s)(Section 7031.5
oyes o No
Business and Professions Code).Any city or county that requires a permit to Dale
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.REPAIRAND 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 Cade)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
❑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( I all of or( )portion of the work,and the structure is www.el3a.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 70",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. o 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 RAP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: ZS v PERMIT/PLAN CHECK NUMBER
PLANNING CASE NUMBER
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
C% NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK ] �. '2 7-e5
U CS zeg0 A
2
PROJECT ADDRESS �y (3� G COL`I� - ZIP �7
ASSESSOR'S PARCEL NUMBER LOT �']lB TRACT `j�j " J
OWNER NAME DR, r , /
ADDRESS 2.-. O W (iJ (f
PHONE !1 f -Z7 Z — C�WO EMAIL (�(/�✓+� /L% �//fjf
APPLICANT NAME
ADDRESS �( CST
PHONE 9�( Z��J EMAIL L O jf
CONTRACTOR'S NAME OWNER BUILDER? O YES O NO
BUSINESS NAME pbwtza S
ADDRESS 2 r500
PHONE !7 J/ dS , EMAIL
CONTRACTOR'S STATE LIC NUMBER L?V_Z9S _ LICENSE CLASSIFICATION U p 3
VALUATION$ Zoo SQFT LSQFT
APPLICANT'S SIGNATURE DATE T
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL GREEN SMIP
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofmenifee.us
ENIFE
�o
s Z
m cziL TATUS MAP { y v
z = Tr# 36485-11 Z o CD
a
m Tr# 36485-3 a .i
N p
rim 0
6 N
Z ^ �
5
21 19 18
17 m
4
o-J 33 1= 0 R 3
31 gg 1 I
g F i
25 29 35 13 2 O 1
26 3fi ® rca c;a
Y�\tM9 22
�DDI Tr# 36485-11
04 , �9 59 Tr # 36485-3 m
Z ( T47
�/'/_ O 52 57 N
EV
H ' 46
fll 3 45 ; v
o`
m s 44
43 yb
42
e
41 on Z
43 ® 1 O 3 4 6O6 9I4 cm%lRl aR6'F 10011 12 ❑ 10 l5 16 17 19 3 sm
1 =$h
9
3g 37 36 35 34 33 72 31 39 29 28 27 26 25 24 23 22
P
O.1E4vA5E9
CD
W
0 v
CD
N CD
� 2
(D
cl
CD
� lJ
I OFFICE COPY