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PMT18-04940 City of Menifee Permit No.: PMT18-04940 29714 HAUN RD. MENIFEE, CA 92586 Type: Commercial Electrical MENIFEE MENIFEE Date Issued: 10/10/2018 PERMIT Site Address: 31633 MENIFEE RD, MENIFEE, CA 92584 Parcel Number: Construction Cost: $10,000.00 Existing Use: Proposed Use: Description of INSPECT DAMAGED SCE ELECTRICAL PEDESTAL,CAUSED BY VEHICLE ACCIDENT Work: NORTHWEST CORNER OF MENIFEE RD AND ALDERGATE DR Owner Contractor VALLEY WIDE PARK&RECREATION ADAME LANDSCAPE INC 901 W ESPLANADE AVE 41863 JUNIPER ST SAN JACINTO, CA 92582 MURRIETA, CA 92562 Applicant Phone: 9516983090 CARLOS ADAME License Number.643164 ADAME LANDSCAPE INC 41863 JUNIPER ST MURRIETA,CA 92562 Fee Description Oft t Amount(51 Building Permit Issuance 1 27.00 Inspections not specified 153 152.60 $179.60 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 Templale.rpt Page 1 of 1 • ^e 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 contmctor(s)pursuant to the Contractors State License Law). Chapter!)(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License Law_ for Professions Code and my� license is in full force and effect. the following reason: tI License Class C Z- License No. �3 ( CO l.� By my signature below I acknowledge that,except for my personal residence Expires -7• f•zfll 01 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 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 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 Code,for the performance of work for which this permit is issued. www.leginfo.ca.gov/calaw.html. Policy# Date T4+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 .4zy my signature below I certify to each of the following:I am the property this permit is issued.My workers compensation insurance carder and policy owner or authorized to act on the property owner's behalf.I have read this number arepp La : trJ� application and the information I have provided is correct.I agree to comply Carrier 17 .S T- with all applicable city and county ordinances and state laws relating to l� building construction.I authorize representatives of this city or county to Polity#g ll�'G'C C.+SISI O�Expires y` `Zn\`� enter the above identified property for inspection purposes. ) (This section need not to be completed is the permit is for one-hundred C./3.2�S .HdC4m4Q Date t© 'L 0' (dr dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT ❑I certify that in the performance of the work forwhich this permit is issued,1 shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# 03G Q 1�z C&I 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 wit those provisions. Will the applicant or future building occupant handle hazardous material or / Applicant NarivAc t comply L Date 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 ❑Yes p 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($1(30,000),IN occupant require a permit for the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist IN SECTION 37060E THE LABOR[ODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY ❑Yes s'Igo 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 gMd 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 al Safety Cade,Section 25505 and 25534 concerning hazardous material reporting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYe. �o Business and Professions Code).Any city or county that requires a permit to /,a \�>, k" vv— Date /0'd�' 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.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. 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 fill out the RRP C1 _ — - c Ae a_ _ Acknowledgement. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION & MENIFEE DATE: In 0. 1 d PERMIT/PLAN CHECK NUMBER l PLANNING CASE NUMBER TYPE: ' MMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: '�ADDITION O ALTERATION O DEMOLITION (ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK �0319ecA E 1 fedabicLl PROJECTADDRESS 31co33 M.ErniF�f �1. ZIP 25 SILI ASSESSOR'S PARCEL NUMBER LOT TRACT OWNERNAME V ,. ADDRESS 70 oA- L PHONE 5(- 6S4- IS0 S EMAIL •p ,c'�r APPLICANT NAME - ADDRESS ( :S S er C'4 L 6Z PHONE 9SI- EMAILC •[an CONTRACTOR'S NAME T OWNER BUILDER? O YES ONO BUSINESS NAME C ADDRESS 2 �Z PHONE EMAIL q,5 M CONTRACTOR'S STATE LIC NUMBER (L 7_6y3j&34 LICENSE CLASSIFICATION Z VALUATION$ Cn.Lp SO FT L SO FT APPLICANT'S SIGNAT DATE CO �.� •<<S' DEPARTMENT DISTRIBUTION ACCEPTED BY:�j CITY OF MENIFEE BUSINESS LICENS]ONO BUILDING PLANNING ENGINEERING FIRE INVOICE TOTAL GREEN SMIP OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE N NOTARIZED LETTER O Y City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777 www.cityofinenifee.us ENIF