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
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