PMT14-00784 City of Menifee Permit No.: PMT14-00784
29714 HAUN RD. Type: Commercial Alteration
MENIFEE, CA 92586
s ,e xa"�k MENIFEE Date Issued: 04/10/2014
lI
PERMIT
Site Address: 29770 BRADLEY RD, Suite#E, MENIFEE, Parcel Number: 336-180-020
CA 92586 Construction Cost: $0.00
Existing Use: Repair Garage Proposed Use:
Description of HOURLY INSPECTION FOR CERTIFICATE OF OCCUPANCY FOR"LOS DESANTIAGO AUTOBODY"
Work:
Owner Contractor
SUSAN STEELE
310 VIA VERA CRUZ STE 202 -
SAN MARCOS, CA 92078
Applicant License Number:
MENIFEE, CA
Fee Description Oy Amountl$1
Inspections not specified 129 129.07
$156.07
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 thereunderwhen 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
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9 (commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Cade and my license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class License No. who builds or improves thereon, and who contracts for the projects with a
Expires Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from licensure under the Contractors'State License Law for the
❑ 1 hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in
compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have
permit is issued. built as an owner-building if it has not been constructed in Its entirety by licensed
Policy# contractors. I understand that a copy of the applicable law, Section 7044 of the
❑ I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site�hltp'//www.leginfo.ca,gov/calaw.htmi.
permit is issued.My workers'compensation insurance carrier and policy number are:
Property caner or Authorized Agent Date
Carrier
Expires Policy#
❑ By my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
construction. I authorize representatives of this city or county to enter the above-
0 1 certify that in the performance of the work for which this permit is issued,I ide ti ed property for he inspection os
shall not employ any persons in any manner so as to become subject to the p � U /'- 0,
workers' compensation laws of California, and agree that if I should become f A ,( j c.vv/ ) aocll �l
subject to the workers'compensation provisions of Section 3700 of the Labor Property Owner or Authorized Agent Date
Code, I shall forthwith comply with those provisions.
City Business License#
Date; Applicant;
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, []YES OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending
INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name []YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ❑NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed []YES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable items)(Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, ❑NO SCHOOL?
or repair any structure, prior to its 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 License Law(Chapter 9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or []YES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST, I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than ($500).) HODS, SECTION
E 3 I ON 25505,
550 R P533O�ff AND 25534 CONCERNING
El 1, as owner of the property, or my employees with wages as their sole
compensation,will do( )all of or ( ) porting of the work, and the structure is PROP�5TY OWNER 0 HORIZED IE
not intended or offered for sale.(Section 7044,Business and Professions Code; ce
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not Intended or offered for sale. If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITE' OF ICY ENIFEE PLCKNo: t o I _ S
29714 Haun Road Date: Date / `�
Menifee, CA 92586 4 w j/4
Phone: (951)672-6777 Amount: Amou :
Fax:(951)679-3843 716(0-
Ck#: Ck#
le
Building Combination Permit G1
To Be Completed By Applicant
Legal Description: L-IT3y1 Planning Case: F: L: Rt: R:
Props Address:_ o As Parcel Number.
2% O a114 Swl ste � e Grp ads
Proje riant Name:
r 1 Q O.�n.i �z .Stt. at. 0 Unit#: Floor#: !I
Name: V Phone No. Fax No.
Property Address:
Owner Unit Number Zip Code
Email Address:
Nam . -\ Phone No. 5i m4-hY Fax Ne.
-S f 4. O 3 _
Applicant Adores&7 bW t M O Z� Unit umber Zio�Co �U
E it Address: .
L '? of CS.S 1` 2 4'1 a1 Wr
ame: Phone No.
Fax No.
Contractor Address: city is Zip Code
Contractor's City Business License No. Contractor's City State of of License No. Classification:
Number of Squares:
Square Footage 1
Description of Work: ZO J a 41 �,Ce O /k}6 1, cd ��4),n Cost of Work:$
7� WTy
Applicant's 5ignature�Jp. - / 4r Date:
'Be Completed By.Clty Staff.Only
Indicate As R-Received or N/A-Not Applicable
5 Completes sets of fully dimensioned,drawn to sale plans which include: 1 set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Gee Tech/Soils Report(on cd only)
❑ Plol/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on&y:x ti)
❑ Foundation Plan El Structural Calculations
❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for also.services over400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan I ❑ Sound Report-Residential
Class Code: Indicate New Construcion Alteration* Addition' Means/Methods
Work Type: Repair' Retrofit* Revislon to Existing Permit' Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories' Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Intlicate Indicate if YES or NO Indicate all Geo-tech.Haz.Zane
At project Construction Sprinklered that apply: Coastal Zone
Completion:
Type(! C rn O YES or NO Noise Zone
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. I 1planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit special Case:Bldg_
Of ci.1A royal
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Stal Use Only
Building/Safety Permit Specialist City Planning I Civil Engineering I PWM-Admin I Transportation Mgmt, I Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
0,A-T ILA-oo-1 8LA
CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENT
ENI 29714 HAUN ROAD, MENIFEE, CA 92586 (A I t 0 hLA
TELEPHONE: (951) 672-6777
APPLICATION FOR CERTIFICATE OF OCCUPANCY
PLEASE PRINT LEGIBLY OR TYPE
SECTION I—APPLICANT INFORMATION
ADDR( SS WHERE BUSINESS WILL BE CONDUCTED:f
NAME OF BUSINESS: TYPE OF BUSINESS:
�os Iodlcpo �o d 0bod
NAME OF BUSINESS OWND^ER // BUSINESS ONE:
t 0S{D SACj+u Z` 1✓7etl Ue )CL
ADDRESS OF HOME OFFICE OF BUSINESS OWNER: Q PHOQNE:
(IF DIFFERENT FROM ABOVE)
OWNER OF BUILDING: `J PHONE:
V,
ADDRESS: CITY: STATE: ZIP: �7
1 ' �`5S;6n p CA- _:�
TI
ESCRIBE EXACTUSE OF ALL PORTIONS OF EACH BUILDING AND LOT:
e W l e 1 1'140u/ -0, A deW .
PREVIOUS USE OF BUILDING:
Nl,e
SECTION 2—APPLICANT DUTIES
1. Applicant agrees to ensure that the Certificate of Occupancy shall be posted in all businesses, which will
operate subject to the City's issuance of Certificate of Occupancy.
—
I, li I�� µes . O , hereby agree to comply with the above-described terms in this Application for
(APPLICANT)
Certif a e of Occu cy.
(AP I NT) (DATE)
FOR DEPARTMENTAL USE ONLY
PLANNING FIRE
ZONE: (J I A INSPECTION DATE(S): fJ Yi
APPROVED BY: DATE: APPROVED BY: DATE:
BUSINESS LICENSE PUBLIC WORKS
BUSINESS LICENS D37Y33
APPROVED BY: DATE: APPROVED BY: DATE:
BUILDING OCCUPANCY GROUP
INSPECTION DATE(S):
APPROVED BY: DATE: r APPROVED BY: DATE:
HAZARDOUS MATERIAL FORM AIR QUALITY PERMIT CHECKLIST
HAZARDOUS MATERIAL DISCLOSURE ENVIRONMENTAL HEALTH RELEASE- FOOD PREP
ENVIRONMENTAL HEALTH RELEASE-HAZARDOUS (IF APPLICABLE)
MATERIALS (IF APPLICABLE) EMWD RELEASE FORM
FLOOR PLAN
REMARKS
I
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i
City of=nifee
APR 10 2014
receive/---
7-7
y y�
6-7
CITY OF M NIFEE
BUILDING ND SAFE
�J PLAN APP OVAL
I ---- --- REVIEWED
'Appi oval of these ans shall not 6
---- app oval o,a viol lien of any prt
re" ordi ances. This se
-- — 10 sieu i i n.
ou
CPO��
Lev I Z
City & MenifeE
Building Safety De I.
APR 10 2014
Received
A1V�S
---------------
TY D4\'MT
DATE
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