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PMT18-04445 City of Menifee Permit No.: PMT18-04445 29714 HAUN RD. Type: Commercial Electrical MENIFEE, CA92586 MENIFEE MENIFEE Date Issued: 09/12/2018 PERMIT Site Address: 26050 MENIFEE RD, MENIFEE, CA 92585 Parcel Number: 331-260-017 Construction Cost: $500.00 Existing Use: Proposed Use: Description of ADD 20 AMP CIRCUIT FOR RECEPTACLE INSIDE EXISTING AM/PM STORE NEAR DELI CASE Work: Owner Contractor. ANDEAVOR OIL PERRY BUILDERS 19100 RIDGEWOOD PKWY 12405 LOCKLEY LANE SAN ANTONIO,TX 78259 AUBURN, CA 95602 Applicant Phone:5307450580 KYLE WADE License Number.731569 PERRY BUILDERS 12405 LOCKLEY LANE AUBURN, CA 95602 Fee Description My Amount 1$) Receptacle, Switch, Outlet&Fixture 1 116.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Electrical 1 5.80 $149.80 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 Law). Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractors State License Law for Professions Code and. y license Is in full force and effect. the following reason: License Class � C-10 License No. —731 S bq By my signature below I acknowledge that,except for my personal residence Expires ? 0710 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 ❑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 fallowing website: by Section 3700 of the Labor Code,for the performance of work for which this permit is issued. www.le infoinfo..ccaa. ov calaw.htmi. p Policy# /? Date 1 (Z 06 have and will maintain workers compensation insurance,as required by PR 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 workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this number are: � pplication and the Information I have provided is correct.I agree to comply L Carrier O Cl) with all applicable city and county ordinances and state laws relating to ��I�� building construction.I authorize representatives of this city or county to Policyp X'WI✓SG764N Expires "3 20 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, I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE q ✓ 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 co with t/hose�p1pp0isions. Will the applicant orfuture building occupant handle hazardous material or a Applicant �'!I`� Date a �- a mixture containing a hazardous material equal to or greaterthat the ��/ ' amounts speeied on the Hazardous Materials Information Guide? WARNING:FAA ETO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes 4; 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 modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quali Management District(SCAQMD)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguideli CONSTRUCTION LENDING AGENCY ❑Yes ❑No I hereby affirm that under the penalty of perjury there is a construction Will the propo d building or modified facility be within 1000 feet of the lending agency for the performance of the work which this permit is issued outer b u ry of a school? (Section 3097 Civil Code) ❑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 Contractors License Law for the reason(s)indicated below by the California He h al Safety Code,Section 25505 and 25534 concerning hazardous aterial reporting. / checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Dyes o�/ / v--- 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 9W<ER 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 IRRP) 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.eoa.aov/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 ❑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 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 as If your project does not comply with EPA RRP rule please fill out the RRP K\i(ewode- Pon{'mt )wI4'ernTI Lc Acknowledgement. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE DATE PERMIT/PLAN CHECK NUMBER CIO s PLANNING CASE NUMBER TYPE: COMMERCIAL CJ RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA OSIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION � ELECTRICAL O MECHANICAL O NEpW11 O PLUMBING O RE-ROOF NUMBER -OFSQUARES DESCRIPTION OF WORK ZO/lhA 6,X.-or 4 " MC4 "At ,A-rpr PROJECTADDRESS Z.6J /it., Ace- ZIP Z ASSESSOR'S PARCEL NUMBER '731 Z6U -O l'7 LOT TRACT OWNER NAME r ke P,- E ADDRESS Q(PL� Kam' t-s.00a (w Sa., AI iD PHONE S�.iL.LA\"'�o l' I`// EMAIL (2 s s :�c •ce`y APPLICANT NAMEWes- ADDRESS '3 't-7 /-/r x lJ o% PHONE �j0-Ljo(-e0I— p EMAIL / 4- @ Gi' 7,Ja . ca. CONTRACTOR'S NAME y'e , OWNER BUILDER? O YES 9NO BUSINESS NAME "!2 &'A r5 yI- . ADDRESS rL,4o<- "ars Last PHONE S�O -LIO L-To VL- EMAIL I ALQ. .e. ry C _ CO CONTRACTOR'S STATE LIC NUMBER -7 3KI61 LICENSE CLASSIFICATION (lj G(c7 VALUATION$ p� ,�G SO FT L SQ FT 0 APPLICANT'S SIGNATURE f` DATE DEPARTMENT DISTRIBUTION ACCEPTED Q>�j CITYOF MENIF BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE ! INVOICE TOTAL I" .� GREEN I SMIP OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE If NOTARIZED LETTER O YES O NO City of Menifee Building &Safety Department 129714 Haun Rd., Menifee,CA 92586 (951)672-6777 www.cityofmenifee.us NIF