PMT18-02661 City of Menifee Permit No.: PMT18-02661
29714 HAUN RD.
MENIFEE,CA 92586 Type: Commercial Electrical
MENIFEE MENIFEE Date Issued: 05/3112018
PERMIT
Site Address: 30340 HAUN RD, MENIFEE, CA 92584 Parcel Number: 360-690-021
Construction Cost: $500.00
Existing Use: Proposed Use:
Description of INSTALL NEW 220V DEDICATED CIRCUIT FOR PASTRY CASE FOR STARBUCKS INSIDE TARGET
Work:
Owner Contractor
TARGET CORP KWC CONSTRUCTION SERVICES INC
PO BOX 9456 26803 STONEGATE DRIVE
MINNEAPOLIS, MN 55440 VALENCIA, CA 91381
Applicant Phone:8775170808
KYLE CARLSON License Number:972615
KWC CONSTRUCTION SERVICES INC
26803 STONEGATE DRIVE
VALENCIA,CA 91381
Fee Description QQrt Amount($I
Services,Switchboards,Control Centers&Panels 1 183.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Electrical 1 9.15
$220.15
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_Pennit_Template.rpt 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 perjury that 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 o I am exempt from Iicensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
Ucense Class Licens By my signature below I acknowledge that,except for my personal residence
Expires 5-Z 1-20 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 DECLARATION 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 fallowing 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 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 website:
by Section 3700 of the Labor Cade,for the performance of work for which WWW.Ieginfo.ca.gov/calaw.html.permit is issued.
Policy# Date
XI have and will maintain worker's 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 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
Carrier S'('�-�4 ri�rA with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# 'I O(�106'3 -7017 Expires 7-zG- 2019 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,
I shall not emolov 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 workk es-comps ation provisions of Section 3700 of the Labor
Code,I shall Rhwi co with rase provisions. WIII the applicant or future building occupant handle hazardous material or a
Applicant Date S-3 1-1 00 mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:F SECURE WORKER'S COMPENSATION COVERAGE 15 o Yes ❑No
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
ADDITION TO THE COST OF COMPENSA7JON�DAMAGES AS_PROVIOEDFOR o¢upant require a permit for the construction or modification from South
IN SECTION 37060F THE LABOR LODE,INTEREST,AND ATTORNEYS FEES - Coast Air Quality Management (SCAOMD)?See permitting checklist -
for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑No
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 o 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
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable items)(Section 7031.5 oYes ❑No
Business and Professions Code).Any city or county that requires a permit to Date
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,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 Iicensure 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. o No EPA Lead-Safe Certified Firm is required for this project because:
❑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 fi11 out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION - MENIFEE
DATE: 1 - it PERMIT/PLAN CHECK NUMBER —Q 1
PLANNING CASE NUMBER
TYPE: .Xa COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION 'O DEMOLITION YO ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK ADD. zoq -Ge c.
City of Men! tram
Building Dept,
'S4 Re-SUCK S ws'olc�f AZ 1
PROIECTADDRESS �p3yp rIA�N P-O J Men;fe-r CA- ZIP
ASSESSOR'S PARCEL NUMBER �:Ol¢O- IOeO— (r!VL\— LOT TRACT pQ^�Ql
OWNER NAME 'Tqr {. SSW S4AP_6t c(C R ecei r`,
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ADDRESS 03 'tO n LogcG fV vl , O
PHONE IS ] 4-IS) EMAIL
APPLICANT NAME (z 1S0^')
ADDRESS t" 'krcc.tS LPG -'
PHONE (,St -7zr gyrYj EMAIL - C-oc
CONTRACTOR'S NAME C�as"c/U OWNER BUILDER? C YES eNO
BUSINESS NAME ic".:c co"sAr-C4,xV tnc
ADDRESS k"2iti A2L'vs LAv C cs Cw' CA �7(3b7
PHONE C S 1 -7 7 s '%yl b EMAIL IG =c� [Cwc Co�Sj�r_c+( ." .(07
CONTRACTOR'S STATE LIC NUMBER G(-7 2(0) 5` LICENSE CLASSIFICATION '
VALUATION$ So C) SO FT L SO FT p
APPLICANT'S SIGNATURE DATE S-sl ,- D
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL rJ GREEN 1 SMIP x
OWNER BUILDER VERIFIED OYES 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
IF