PMT18-03436 City of Menifee Permit No.: PMT18-03436
29714 HAUN RD.
Type: Commercial Electrical
'j MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued: 0 7124/2 0 1 8
PERMIT
Site Address: 26668 MCCALL BLVD, MENIFEE, CA Parcel Number: 335-171-013
92585 Construction Cost: $550.00
Existing Use: Proposed Use:
Description of TEMP POWER POLE 100A FOR JACK IN THE BOX
Work:
Owner Contractor
BESHAY&FONG PROPERTY LLC RIGHTWAY SITE SERVICES INC
41760 IVY STREET, SUITE 201 653 WEST MINTHORN
MURRIETA,CA 92562 LAKE ELSINORE, CA 92530
Applicant Phone: 9516748608
REBECCA BANAC License Number:891951
RIGHTWAY SITE SERVICES INC
653 WEST MINTHORN
LAKE ELSINORE. CA 92530
Fee Description Oft Amount 1E1
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 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 70D0)of Division 3 of the Business and ❑I am exempt from licensure under the Contractors State License Law for
Professions Cade and my license is in full force and effect. the following reason:
License Class License No. t"3 1 19
L S 1 " _,,�A' By my signature below I acknowledge that,except for my personal residence
Expires 2q n tureD6',t� Qit 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 www-leginfo.ca.gov/calaw.html.permit isissued. C� ( � ,,/ / (�
PolicyA \�-1—w C_ ("l Z� �l `3(y` I Date
'F PROPERTYOWNER OR AUTHORIZED AGENT
❑I have and will maintain workers compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which in By my signature below I certify to each of the following:I am the property
this permit is issued.My workers compe; iQn insurar a w�rrler and palicy� owner or authorized to act on the property owners behalf.I have read this
number are: \ 3^) �2 1 t/O� 3 G 1 - I application and the information 1 have provided is correct.I agree to comply
Carrier �"�{ ) F,`(�Q.. W�� C�rS�. ,,� with all applicable city and county ordinances and state laws relating to
��+`, ` building construction.I authorize representatives of this city or county to
��
Policy# 1S1VV����7 z-J Expires C /3n1� 1 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
❑I certify that in the performance of the work for which this permit is issued, 2 C 1 (3 1 -ram/(
1 shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE q - ✓ 1 1 I�,j
worker's 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
Cade,I shall forthwith comply with thos"rowsions. Will the applicant orfuture building occupant handle hazardous material or a
tam
1 '/ r-s/ mixture containing a hazardous material equal to or greater that the
Applicant K-L-GY ovlDate��.i amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES _ _Willthe.intended.use.otthebuilding.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 modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?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 Cade) ❑Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
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(s)I have placed next to the applicable item(s)(Section 7031.5
DYes ❑No
Business and Professions Cade).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 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( )all of or( )portion of the work,and the structure is www.epa.gov/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 ❑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. ❑No EPA Lead-Safe Certified Firm is required forthls project because:
❑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 jZM!EN1FEE
DATE: PERMIT/PLAN CHECK NUMBER
GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: 'COMMERCIAL ()RESIDENTIAL O MULTI-FAMILY () MOBILE HOME ()POOL/SPA Cg_Ml ing Dept.
SUBTYPE: (F)ADDITION O ALTERATION ()DEMOLITION ELECTRICAL () MECHANICAL JUL 10 2018
O NEW ()PLUMBING ORE-ROOF NUMBER OFtUARES
DESCRIPTION OF WORK
OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERS o YES ()NO
PROJECTADDRESS �Q��� MG�ti11 13�vc�, mr�k�PQ ZIP CPT 97_C�86'
ASSESSOR'S PARCEL NUMBER 13 � 1, Q` LOT W/A- TRACT
OWNER NAME "
11
ADDRESS 4 I-I 2 rri 9 _
PHONE �)y�-Q� � EMAIL
APPLICANTNAME `l l � �L,
ADDRESS G ZS
PHONE QRS1) EMAIL
CONTRACTOR'S NAME OWNER BUILDER? ()YES®NO
BUSINESS NAME S, Q
ADDRESS 155; vv_
PHONE �tl 47I —I�ZZf�� EMAIL Z�
CONTRACTOR'S STATE LIC NUMBER Rgk1 s I, LICENSE CLASSIFICATION C"4
VALUATION$ 5 5O -o^Oor�� -DSO FT�,,,,,,�, L SQ FT
APPLICANT'S SIGNATURE \ WIC---C.-1 \�JW 1\V`� DATE 2-C)
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE to
INVOICETOTAL GREEN 1 SMIPov X
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.cityofm enifee.us
CONTRACTOR'S INFORMATION SHEET
City of Menifee
Building Dept.
ATTN: Department of Building and Safety JUL 10
2018
Company Name and Address as shown on contractor's license is: R E)ce ` ed
Rightway Site Services, Inc. ' `G 'V G
653 W. Minthorn St.
Lake Elsinore, CA.92530
Company Telephone Number: (951)674-8608
Contractors Contact Person: Robert M. Harding
CA State Contractor's License Number: 891951
License Classification: C10 C42
I, Robert M. Harding, President,certify that the persons listed below are the only authorized persons to
pull permits for Rightway Site Services, Inc.and the contractors that I represent under the above
contractor's license number until further written notice is given.
1. Robert M. Harding 2. Gary Wood
3. Rebecca Banac
�A��lL t3 'n�c is;zY D �OJb'
Robert M. Harding, President Date
STATE OF CALIFORNIA}
COUNTY OF RIVERSIDE} ss
On this o2DT— day of rcgexo4iLY in the year of .9 e 18 before me,the undersigned, a Notary
Public in and for said County and State, personally appeared Robert M. Harding proved to me on the
basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and
acknowledged that he executed the same.
ANNA MARIE KIMBLE
Commission 12125528 z
Signature: C < Ic ¢ L LL z:=:- Notary Public-California a
z " Riverside County
My Comm.Ex Ire.Be 2,2819+
Name: Ampirk Mfka.tC- IljTMFLL-
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