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PMT18-02363 City of Menifee Permit No.: PMT18-02363 29714 HAUN RD. Type: Commercial Electrical <ACCEL/-> MENIFEE,CA 92586 MENIFEE Date Issued: 05/16/2018 PERMIT Site Address: 31715 ROUGE LN, MENIFEE, CA Parcel Number: Construction Cost: $500.00 Existing Use: Proposed Use: Description of INSTALL ONE 200 AMP UNDERGROUND TEMP POWER POLE TO PROVIDE POWER TO Work: CONSTRUCTION AT TR28206&28206-3.TEMP POWER POLE LOCATED AT TR28206-NNDSOR Owner Contractor PULTE HOMES S R BRAY LLC 27101 PUERTA REAL STE 300 1210 N RED GUM STREET MISSION VIEJO, CA 92621 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 O_yt Amount 151 Services,Switchboards, Control Centers&Panels 1 183.00 Building Permit Issuance 1 27.00 Administrative Fee 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 carded 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 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 cintractor(s)pursuant to the ContractouState License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractors Stale License Law for Professions Code and my license is in full force and effect. the following reason: License Class C10 License No. By my signature below l acknowledge that,except for mypersonal residence Expires 71 in which l musthave resided for at least one year prior to completion of WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legallysella structure that I have built as an owner-bullder if it has not been constructed in its entirety by D 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 wvnv.leeinfo.ca.eav/calaw.html. this permit is issued. Policy If Date az'(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 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 I have provided is coned.I agree to comply Carrie,ge--i )(/it rNJLI(/(rlfi� Ah1rFk"J with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy#CL-61�71/,73o7DZ Expires 3131�1Q 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 I certify that in the performance of the work for which this permit Is issued, 03 � r I shall not emolav 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,l shall forthwith comply wit visions. Will the applicant or future building occupant handle hazardous material or Applicant Dale /7///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 aYes ed4-o 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 modiRcation from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist IN SECNON 37136 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines CONSTRUCTION LENDING AGENCY aYes eiNo I hereby offirmthat 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) a Yes "a OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that 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 report. g. Business and Professions Code).Any city or county that requires a permit tos ❑N�' // /� Date construct,alter,Improve,demolish or repair any structure,prior to its PROPERTY OWNERO 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(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]!censure 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( )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 70",Business and Professions 1-800-424-LEAD(5323). Code;The Contractors State License Law does not apply to an owner of a D 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 safe. D No EPA Lead-Safe Certified Firm is required for this project because: o 1,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. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE DATE: j PERMIT/PLAN CHECK NUMBER TI - DZ31�3 PLANNING CASE NUMBER TYPE: O COMMERCIAL e'RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION V- C CCTRICAL O MECHANICAL O NEW O PLUMBING C) RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK f-fj 0- ONO-5 VQ A)%p IfI& -rvy, 6c or ozz -n ,8wu 6W -fD ca+1`riu crW-1 T i ZPZoln � PROJECTADDRESS ZIP �/ 2 ZQ(o i ASSESSOR'S PARCEL NUMBER LOT TRACT�f ZeZ '6- OWNER NAME (/GT£ AlLef ADDRESS 27(6) fuEGTq X4e 5T6 00 /SJ virablo CIA 9)Z&ZI PHONE �" -6?? -3700 EMAIL APPLICANT NAME C&E ADDRESS PHONE 95/-293 -1333 ✓ EMAIL MrkF-,4q GG PoL4gepe&r, eohl CONTRACTOR'S NAME OWNERBUILDER? OYES A-M BUSINESS NAME ADDRESS /ZI0 Jv, &Z Gz+h ST AN04A 92P46, PHONE 13rl- 7,17 -ITJ7 EMAIL CONTRACTOR'S STATE LIC NUMBER 9865'dI LICENSE CLASSIFICATION C/o VALUATION$ 5�0 SO FT L SO FT APPLICANT'S SIGNATURE ��- DATE 5'-//-10' Cj Y DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING EN EERING FIRE I C) INVOICE TOTAL 20, ( EEN l ,W SMIP �' OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO City of Menifee Building &Safety Department 129714 Haun Rd. MeniI Cps8 86(951)672-6777 www.cityofinenifee.us �g O' '•'eT11T Building Dept. SNIP MAY 1 1 2918 Received n aw C_1 { f LOT 65(OPS-ACE) Z. r J C{ ® N 4 dOO N N -1 .. :; T D z -n OC M Er b C N N z o a q -9 3 .. h] p 4 00 0 ❑ 3 � D v � 0 1.. x w tA OD 0% S' • • N d O 3 (,V N �■.� � ' EF N V _ _ q a N • • D Cl ' w n 1AYpQ � a m u v N , . • u P N a u H N • - N P 1 � = 4 � P D Z 4 m m V O V w A o � c— a N 4 O V V a M"'� ❑ v u Y T s N � � P u u 4 a O m a o o 4 N+ O O a V P V a t y P/LOR/ RW Ln f+