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PMT14-03103 City of Menifee Permit No.: PMT14-03103 29714 HAUN RD. Type: Commercial Alteration '9i6C11EL #` MENIFEE, CA 92586 MENIFEE Date Issued: 11/20/2014 PERMIT Site Address: 28067 BRADLEY RD, MENIFEE, CA Parcel Number: 337-302-009 92586 Construction Cost: $0.00 Existing Use: Office Proposed Use: Description of HOURLY INSPECTION FOR CERTIFICATE OF OCCUPANCY FOR"VACUUM R US" Work: Owner Contractor RICHARO ROMERO 7111 HORIZON CT RIVERSIDE, CA 92509 Applicant License Number: Fee Description ,4�tr Amount is Buldfil9- re I� S'a,G p� 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 thereunder when in violation of the Building Code or of any other ordinance of City of Menifee. Except as otherwise staled,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 Code 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 ❑ I 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 ❑ 1 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:httt),//www.leciinfo,ca.gov/calaw.html. permit is issued.My workers'compensation insurance carrier and policy number are: Property Owner or uthorize 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($100)or less) with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to enter the above- ❑ I certify that in the performance of the work for which this permit is issued,I identified property for the inspection purposes. shall not employ any persons in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become !I-2p•/$ 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; //-20J // : Applicant; .-/�'/-�-r_ - 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, AYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A _ DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES ONO 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 DYES 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 DYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY next to the applicable item(s)(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 (Chapter9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL Section 7000)of Division 3 of the Business and Professions Code)or that he or DYES 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).) CODE, SECTION 25505 25533 AND 25534 CONCERNING ❑ 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL IAEPOWNG. compensation, will do( )all of or( ) porting of the work, and the structure is PROPERTY OWNER ORAUTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; 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). i CITY OFMENIFEE PERMIT # -J;;M- IV4-03 ��� BUILDING AND SAFETY DEPARTMENT 29714 HAUN ROAD, MENIFEE,CA 92586 TELEPHONE:(951)672-6777 DATE: 1\ ) Z© ) I --) APPLICATION FOR CERTIFICATE OF OCCUPANCY PLEASE PRINT LEGIBLY OR TYPE SECTION I-APPLICANT INFORMATION PN - - 30 -O© ADDRESS WHERE BUSINESS WILL BE CONDUCTED: gu f t7y �d6� BR ltti O 925�IG NAME OF BUSINESS: TYP An E OF BUSINESS. g=12L2 M2 K It 6 EM14 NAME OF BUSINESS OWNER: BUSINESS P ONE: C�LObtYk 62 O Jq r46) (07 9 -' '677 ADDRESS OF HOME OFFICE OF BUSINESS OWNER: PHONE: (IF DIFFERENT FROM ABOVE) -1 11 14 0V 1-4ClV tU s)Dgzr OWNER OF BUILDING: PHONE: A RL=t 5 3d !- 333S ADDRESS: CITY: STATE: ZIP; 21 �i 17 "tYV /ur,c'l CA 2sary6 DESCRIBE EXACT USE OF ALL PORTIONS OF EACH BUILDING AND LOT: `Jr PREVIOUS USE OF BUILDING: s Lt,F�5 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 Citys issuance of Certificate of Occupancy. I, RlCAi-kV i /ZONIPX S . hereby agree to comply with the above-described terms in this Application for (APPLICANT) Certificate of Occupancy. . <�l1 _ l / - 2 0 (APPLICANT) (DATE) FOR DEPARTMENTAL USE ONLY PLANNING FIRE ZONE: (17C APPROVED BY: DATE:JAW APPROVED BY: DATE: BUSINESS LICENSE PUBLIC WORKS/ENGINEERING BUSINESS LICENSE# 0 '�el 17 APPROVED BY: DATE: APPROVED BY: DATE: BUILDING DEPARTMENT EASTERN MUNICIPAL WATER DISTRICT APPROVED BY: DATE: APPROVED BY:—w-a—DATE: HEALTH DEPARTMENT APPROVED BY: Iv DATE: REMARKS i CITY OF MENIFEE I BUILDING AND SAFETY DEPARTMENT Tenant Disclosure Form PERMIT No. Property Address_ AFL Y_ RD Swu ct-5 2S g6 Street NamelNumber Area/Community zip code Business name: c in, t Suite name: _-- Stark r1 � �13vu� Occupancy group: Square footage: q d Type of construction: Is the building equipped with fire sprinklers BLS Number of Employees: l Number and location of restroom facilities: 1 List any chemicals used or stored and quantities: fatorrC- Are you making any improvements to the suite or building other than painting, papering, floor covering, movable cases, counters or partitions not over 5 feet 9 inches high? _ N 0 Are you a new tenant? E S Are you the first tenant? __ hj 6 Plans Required: e If you are not doing any work that requires a permit, please provide four copies of a plot plan and a floor plan. ®If you are making other improvements, please see the Tenant Improvement Plan Requirements handout. Signature Print Name Gate Circle One: Tenant / Owner / Contractor / Architect / Engineer