PMT18-04958 City of Menifee Permit No.: PMT18-04958
29714 HAUN RD.
Type: Commercial Electrical
j F MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued: 10/31/2018
PERMIT
Site Address: 29012 NEWPORT RD, MENIFEE, CA Parcel Number: 340-040-029
92584 Construction Cost: $5,000.00
Existing Use: Proposed Use:
Description of INSTALL 1/2"CONDUIT FOR POWER TO NEW REACH IN COOLER AT AM/PM; NEW 30AMP
Work: BREAKER IN PANEL
Owner Contractor
ANDREA SHREMELIS BRIGHT BULBS ELECTRIC CO INC
29012 NEWPORT RD 17915 RAMONA AVENUE
MENIFEE, CA 92584 FONTANA, CA 92336
Applicant Phone: 9092323354
MELVIN CABALLERO License Number: 1004286
BRIGHT BULBS ELECTRIC CO INC
17915 RAMONA AVENUE
FONTANA, CA 92336
Fee Description QQt rr Amount($j
Receptacle, Switch, Outlet&Fixture 2 121.00
Building Permit Issuance 1 27.00
Inspections not specified 153 152.60
Additional Plan Review Building 153 152.60
GREEN FEE 1 1.00
General Plan Maintenance Fee-Electrical 1 6.05
$460.25
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 my license is in full force and effect. the following reason:
License Class License No. By my signature below I acknowledge that,except for my personal residence
Expires 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 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 www.leginfo.ca.gov/calaw.html.
this permit is issued. �7f�
Polity# ( 3 T v� 16 l Date
❑I 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
�r C Carrier p�s� �`\ with all applicable city and county ordinances and state laws relating to
—7.- building construction.I authorize representatives of this city or county to
Policy# (3 i2 S_trb'70 7- Expires [ 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 employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's c py�rsati V provisions of Section 3700 of the Labor
Code,I shall f2aWK4t with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant l Date / mixture containing a hazardous material equal to or greater that the
amounts spp .cified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO 5 RE WORKER'S COMPENSATION COVERAGE IS ❑Yes efNo
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 Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes 77 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) ❑Yes &No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California He Ith&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardou ateria o g��
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes
Business and Professions Code).Any city or county that requires a permit to Date G /
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWMER OR UT IZED 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 Contractor's State EPA RENOVATION,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
o 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 Contractor's 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. ❑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 Contractor's 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. f
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: 10/10 PERMIT/PLAN CHECK NUMBER f7NCt p "
GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: ''' COMMERCIAL RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME ®POOL/SPA 0 SIGN
SUBTYPE: (}ADDITION ;___'ALTERATION DEMOLITION E)ELECTRICAL ®MECHANICAL
NEW DPLUMBING C'RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK Install 1/2" conduit for power to new reach in cooler at AM/PM; New breaker
in panel.
OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERS r'YES C.NO
PROJECT ADDRESS 29012 Newport Rd. ZIP92584
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME Andrea Shremelis
ADDRESS 29012 Newport Rd.
PHONE 562-881-6185 EMAIL mrobinson@permitplace.com
APPLICANT NAME Mike Robinson
ADDRESS 13400 Riverside Dr. Suite 202, Sherman Oaks, CA 91423
PHONE 213-308-0674 EMAILmrobinson@permitplace.com
CONTRACTOR'S NAME Melvin Caballero OWNER BUILDER? OYES(:-)NO
BUSINESS NAME Bright Bulb Electric
ADDRESS 29012 Newport Rd.
PHONE 909-232-3354 EMAILJkassity@apeximagingservices.com
CONTRACTOR'S STATE LIC NUMBER 1004286 LICENSE CLASSIFICATION C10
VALUATION$ 59000 SQ FT na L SQ FT
APPLICANT'S SIGNATURE DATE 10/1 0
•
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS UCENNSE NUMBER
BUILDING PLANNING ENGINEERING FIRE 1//
INVOICE TOTAL 1 GREEN O� SMIP
OWNER BUILDER VERIFIED =%YES NO DRIVERS LICENSE# , NOTARIZED LETTER YES NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-677
GSv o�
city of Menifee wwwbtyofinenifee.us
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Building Dept MENIFEE
OCT 11 ��1� :