PMT14-03300 City of Menifee Permit No.: PMT14-03300
29714 HAUN RD. Type: Commercial Alteration
MENIFEE, CA 92586
MENIFEE Date Issued: 12/12/2014
PERMIT
Site Address: 26930 CHERRY HILLS BLVD, MENIFEE, Parcel Number: 337-320-016
CA 92586 Construction Cost: $0.00
Existing Use: Proposed Use:
Description of HOURLY INSPECTION FOR CERTIFICATE OF OCCUPANCY FOR"BEST PHARMACY"
Work:
Owner Contractor
CHERRY HILLS PLAZA, LLC
26834 CHERRY HILLS BLVD
MENIFEE, CA 92586
Applicant License Number:
HETAL&RESHMA PATEL
26930 CHERRY HILLS BLVD
MENIFEE, CA 92586
Phone: 9516797988
Fee Description Piz Amount f$1
6!
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 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 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:htto//www.leciinfo.ca.ciov/calaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier Property Owner or Authorized Agent Date
Expires Policy#
❑ By my Signature below, I certify to each of the fallowing: I am the property
Name of Agent Phone# owner or authorized to act on the property owner's behalf. 1 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 iden�d property for the inspection purposes.
shall not emolov any persons in any manner so as to become subject to the /
workers' compensation laws of California, and agree that if I should become
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, DYES 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 El 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
OWNER BUILDER DECLARATIONS GUIDE LINES
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 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 (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).) CODE, SECTION 25505, 25533 AND 25534 CONCERNING
El1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING.
compensation, will do ( ) all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED 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).
CITY OF MENIFEE PERMIT # P 1 1 14- D'300
BUILDING AND SAFETY DEPARTMENT
0 29714 HAUN ROAD, MENIFEE, CA 92586
TELEPHONE: (951)672-6777 DATE: City of Menifee
Building & Safety Dept.
APPLICATION FOR CERTIFICATE OF OCCUPANCY DEC 12 2014
PLEASE PRINT LEGIBLY OR TYPE
SECTION I—APPLICANT INFORMATION
ADDRESS WHERE BUSINESS WILL BE CONDUCTED:
2693O C. Nwl W115 B1Vd MehIfee. CA 92-sob
NAME OF BUSINESS: TYPE OF BUSINESS:
13esF Rx Noxv"o-c e+Oa 1 Phtwvhac y
NAME OF BUSINESS OWNER: BUSINESS PHONE:
HP-W P- PoLte-L antra Restw .e T Niel_ 451 - 679 -7988
ADDRESS OF HOME OFFICE OF BUSINESS OWNER: PHONE:
(IF DIFFERENT FROM ABOVE)
a7735 BO/&A COUP+ 3639 E. Ridyway Rd - (5-6z) 650 -S237
M"iFee cA+ 92_5_8s OYmn CA 92-007 7/1 - 32-1- Z.805-
OWNER OF BUILDING: PHONE:
Chou q 40s PIAza,ue . qsI - elf-0 - 5,9%6
ADDRESS: CITY: STATE: ZIP:
Z6ulq Chewyl pis T614A Mev%I(ee-
Cf+ gzse6
DESCRIBE EXACT USE OF ALL PORTIONS OF EACH BUILDING AND LOT:
Re4a-i'I aco
PREVIOUS USE
USE OF BUILDING:
�AA,kk I 1-hOv�w�w
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, B e, WL P0.le-L hereby agree to comply with the above-described terms in this Application for
(APPLICANT)
Certificate of Occupancy.
A-1 'I I2//2, 11
(APPLICANT) (DATE)
t-
CITY OF MENIFEE
citSUII«tQING AND SAFETY DEPARTMENT
Building & Safety Dept.
DEC 12 20Tenant Disclosure Form
Received PERMIT No. �
Property Address 269 3o eticrc-I Hills '61,jd 92se6
Street Name/Number Area/Community zip code
Business name: Bert- Rx ?6a rnatu
Suite name:
Occupancy group:
Square footage: 27co
Type of construction: NcLW,4
Is the building equipped with fire sprinklers Yes
Number of Employees: Z
Number and location of restroom facilities:
List any chemicals used or stored and quantities: ti,,;je
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? ivu
Are you a new tenant? Yes
Are you the first tenant? Nb
Plans Required:
♦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 Date
Circle One: Tenan / Owner / Contractor / Architect / Engineer