PMT18-02716 City of Menifee Permit No.: PMT18-02716
AV A 29714 HAUN RD.
MENIFEE, CA 92586 Type: Commercial Electrical
LEE MENIFEE Date Issued: 0 611 3/2 01 8
PERMIT
Site Address: 29743 NEW HUB DR, MENIFEE,CA Parcel Number: 336-380-014
92586 Construction Cost $2,500.00
Existing Use: Proposed Use:
Description of INSTALL 200A TEMP POWER POLE WITH 1 SERVICE POLE AND 6 SPAN POLES TO PROVIDE
Work: POWER TO SMART&FINAL CONSTRUCTION
Owner Contractor
REGUS MCCOY S R BRAY LLC
31620 RAILROAD CANYON ROAD 1210 N RED GUM STREET
CANYON LAKE,CA 92587 ANAHEIM, CA 92806
Applicant Phone:7145071881
VIC LUNA License Number: 980589
S R BRAY LLC DBA POWER PLUS
1210 N RED GUM STREET
ANAHEIM,CA 92806
Fee Description Qtv Amount($1
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 9A 5
$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 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
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License late).
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. 9 aJ��'�'/ _ the following reason:
License Class/.d C r u /Jy// License No. - By my signature below I acknowledge that,except for my personal residence
Expires Signature in which l must have resided for at least one year prior to 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: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 370D of the Labor Code,for the performance of work for which wtvW.leelnfo.ca.eov/calaw.html.
this permit is iss
Policy gr� Date
, Fl ave and will maintain workers compensation Insurance,as required by PROPERTY OWNER OR AUTHORIZEDAGENT
section 3700 of the Labor Code,for the performance of the work forwhich ❑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
numberare: application and the Informatlan I have provided is correct.I agree to comply
Ly�y� pu�(r`L with all applicable city and county ordinances and state laws relating to
Carrier At
3 , building construction.l authorize representatives of this city or county to
A Policy tC a n)_17p Expires `.3/3 f//a 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 mannerso as to become subject to the CITY BUSINESS LICENSE 9
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 tv ossee provisions. Will the applicant or future building occupant handle haEardous material or a
Applicant Date mixture containing a hazardous material equal to orgreater that the
amounts specified an the Hazardous Materials Information Guide?
WARNING:FAILURE TO iC E WORKER'S COMPENSATION COVERAGE IS o Yes EN0
UNLAWFUL,ANDSHA BJECF 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 madiriation from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY oyes �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 school?
(Section 3097 Civil Code) Dyes .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&Safety Cade,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the .
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes IGNo
Business and Professions Code).Any city or county that requires a permit to Date/B-(6 .f �
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWN THORIZEDAGENT
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 RENOVAT ON.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 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
❑1,as owner of the property,or my employee With wages as their sole employees.For mare information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is W WW.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-8D0-424-LEAD(S323).
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.: i
completion,the Owner-Builderwill 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 project because:
o I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Caere: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
- AZAA Si
DATE: 43 PERMIT/PLAN CHECK NUMBER
City of Men' ee
PLANNING CASE NUMBER Building Dejxt.
TYPE: O COMMERCIAL O RESIDENTIAL 4 MULTI-FAMILY 0 MOBILE HOME O POOL/SPA
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK `Z� A /
PROJECTADDRESS �a � ��a�1'1�r'('�� {2 ZIP
ASSESSOR'S PARCEL NUMBER J ?2W 'O LOT TRACT
OWNER NAME SUU4 /L
ADDRESS L117 `z 'Tg ST �P_ C 264-3
PHONE EMAIL
APPLICANT NAME C
ADDRESS 8gD c/IJOG//
PHONE Q ft `� 9Sl �S/ '' SbEMAIL
CONTRACTOR'S NAME G�/L G.v OWNER BUILDER? O YES O NO
BUSINESS NAME
ADDRESS Z / /S� s -4
PHONE EMAIL
CONTRACTOR'SSTATELICNUMBER 980SS / LICENSE CLASSIFICATION 15
VALUATION$ Z S0 G SQ FT L SO FT
APPLICANT'S SIGNATUR /�� DATE r
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITYOF1YylENIFEE$U51�ICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE J�/`55 LL'IJJ1/o2
INVOICE TOTAL b,1C5 GREEN 1� SMIP x
OWNER BUILDER VERIFIED OYES 0 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.cityofinenifee.us
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