PMT18-06057 City of Menifee Permit No.: PMT18-06057
29714 HAUN RD.
MENIFEE, CA 92586 Type: Commercial Electrical
MENIFEE MENIFEE Date Issued 01/02/2019
PERMIT
Site Address: 27551 KOBUK VALLEY DR, MENIFEE, CA Parcel Number: 333-170-077
92585 Construction Cost: $1,000.00
Existing Use: Proposed Use:
Description of INSTALL ONE U/G 400 AMP TEMP POWER POLE W/TWO SUB PANELS, TO POWER TRIPLE WIDE
Work: SALES TRAILER TR 34406-6 CHELSEA
Owner Contractor
LENNAR HOMES OF CA S R BRAY LLC
980 MONTECITO DR#302 1210 N RED GUM STREET
CORONA, CA 92879 ANAHEIM, CA 92806
Applicant Phone: 7145071881
SHANNON GONZALEZ License Number: 980589
S R BRAY LLC
1210 N RED GUM STREET
ANAHEIM, CA 92806
Fee Description y Amount
Services, Switchboards, Control Centers& Panels 1 183.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Electrical 1 9.15
$220.15
The issuance of this permit sh_01 not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carrled 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 perjurythat I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Cha pie r9(commencing with sec t!an 7000)of Division 3 of the Business and ❑1 am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect, e, the following reason:
License Class C^(6 License No. o
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
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
O I hereby affirm under penaltyaf perjury one of the following de[laratlans:I have built as an owner-builder if it has not been constructed in its entirety by
licensed contractors.I understand that a copy of the applicable law,5ection
have and will maintain a ca rtJfi cate of consent of self-insure for worker's 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the 01re Etc r of Industrial Relations as provided for
by Section 3700 of the Labor Code,for the performance of work for which this application is submitted or at the following website:
this permit is Issued, www.IL-Rinfo.ca.gay/calaw-htrni.
Policy#
/ Date
w1 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 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.!have read this
number are: appiication and the Inform at Ion I have provided is correct,i agree to comply
Carrier v'C r✓e_ IZt S� with all applicable city and county ordinances and state laws re)a tin g to
Policy#5N36 iKv building construction.I authorize representatives of this city or county to
Expires 3 ��� t enter she above identired property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less Date
o I certify that in the performance of the work for which this permit is issued, PROPERTY OWNER OR AUTHORIZED AGENT
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE q
worker's compensation laws of California,and agree that if I should become
subject to the workers compensation provisions of Section 3700 of the Labor HAZ4RDOU5 MATERIAL DECIA RAT ION
Code,I shall f i h comply th hose provisions. — Will the applicant or future building occupant handle hazardous material or a
Applicant Date It 70 1 V mixture containing a hazardous material equal to or greater that the
WARNING;FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS Yesnts 4.specified on the Hazardous Materials Information Guide?
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES s
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN Will the intended use of the building by the applicant ar future building
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the Construction or modlflca tic n from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
CONSTRUCTION LENDING AGENCY for guidelin 5
0 Yes
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 bour}pary of a school?
(Section 3097 Civil Code) ❑Yes 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
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have Placed next to the applicable Item(s)(5ection 7031.5 zconstruct,
Emz
Business and Professions Code).Any city or county that requires a permit to alter,improve,demolish or repair any structure,prior to its Dateissuance,also requires the applicant for the permit to fife a signed statement AGENT
that he or she is iltensed pursuant to the provisions aFthe Contractors State EPA RENOVATION,REPAIR AND PAINTING I RRP
License Law(Chapter 9(commencing with 5ection 7000)of Division 3 of the
Business and Professions Code)ar that he or she is exempt from licensure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for mast work that disturbs paint in a pre-1978
an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to be RRP-certified firms and comply with
than($500). required practices.This Includes rental property owners and property
ma nagers who n 1, d
as owner of the property or my employee with wages as thelr sole employes For m are e info rmationraba t EPXthem
R novat on Prtogram vis i t:
compensation,will do( )all of or( )portion of the work,and the structure is www.e DO.g2vJlead or contact the National Lead Informetlon Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-500-424•LEAD 15323).
Code;The Cantractvils State License Law does no[apply to an owner of a
property who,through employees'or persona!effort,builds or improves the 0 An EPA Lead-Safe Certified Renovator will be responsible for this project
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
completion,the Owner-Builder will have the burden of proving that it was Firm Certification No.:
not built or Improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project because:
0 1,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.
BUILDING & SAFETY PERMITIPLAN CHECK APPLICATION ME_NIFEE
DATE: 12/18/18 _ r PERMIT/PLAN CHECK NUMBER MWO
GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE:. COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O=SIGN
SUBTYPE: OADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW OPLUMBING ORE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK INSTALL ONE 400 AMP TEMP POWER POLE TO POWER AND TWO
SUB PANELS, TO POWER TRIPLE WIDE SALES TRAILER.
OCCUPANCY GROUP_ CONSTRUCTION TYPE TEMP PWR SPRINKLERS O YES (j)NO
PROJECTADDRESS �, ZIP
ASSESSOR'S PARCEL NUMBER 333-170-077 LOT Lj TRACT34406-6
OWNER NAME LENNAR
ADDRESS 980 MONTECITO DR. STE #302, CORONA, CA 92879
PHONE 951-817-3500 EMAIL
APPLICANT NAME SHANNON GONZALEZ
ADDRESS 2750 N PERRIS BLVD, PERRIS, CA 92571
PHONE 951-293-1467 EMAIL '4D.:a� /cZ aa�£� i.�s Go r✓1
CONTRACTOR'S NAME S.R. BRAY LLC �J OWNER BUILDER? OYESQNO
BUSINESS NAME DBA POWERPLUS
ADDRESS 1210 N REDGUM ST, ANAHEIM, CA 92806
PHONE 714-765-7551 EMAIL
CONTRACTOR'S STATE LIC NUMBER 980589 LICENSE CLASSIFICATION C-10
VALUATION$ 1 000 SQ FT L SQ FT
APPLICANT'S SIGNATURE ��� DATE 1 2/1 8/1 8
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY' CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL r�U .1S GREEN l SMIP
OWNER BUILDER VERIFIED YES :* NO DRIVERS LICENSE# NOTARIZED LETTER YES ) NO
City of Menifee Building Safety Department 129714 Ilaun Rd,, Menifee, CA 92586 (S61)672. 777
www,cftyofinenifee,u a
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