PMT14-03375 j
i
City of Menifee Permit No.: PMT14-03375 j
29714 HAUN RD. Type: Commercial Alteration
WCCEL.%l? MENIFEE, CA 92586
ea"""s"xWk" n MENIFEE Date Issued: 1 212 3/2 0 1 4
i
i'
PERMIT
Site Address: 27851 BRADLEY RD, Suite#180, Parcel Number: 335-201-004
MENIFEE, CA 92586 Construction Cost: $0.00
Existing Use: Proposed Use:
Description of HOURLY INSPECTION FOR C OF O"AUNG THU, MD, INC
Work:
Owner Contractor
SUN PLAZA BUSINESS CENTER, LLC ,
41890 S ENTERPRISE
SUITE 100
Applicant License Number:
MENIFEE, CA
Fee Description
(3yl Amount is
Buildlgg Permit Issuance ` `" X- _ 1 27 OQ
Inspections not specified 129 129.07
$166.07
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'Slate 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:http'//www.leQinfo.ca.qov/calaw html.
permit is issued. My workers'compensation insurance carrier and policy number are:
Property wner 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 slate laws relating to building
construct! r.�I authorize representatives of this city or county to enter the above-
El I certify that in the performance of the work for which this permit is issued,I identi iedP' prop# y 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 -
subject to the workers'compensation provisions of Section 3700 of the LaborC—,pert. wner or Author'._a 9 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 OYES 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 reasons)indicated below by the checkmark(s)I have placed AYES 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 I HAVE READ THE HAZARDOUS MATERIAL
provisions of the Contractor's State License Law (Chapter 9 (commencing with
Section 7000)of Division 3 of the Business and Professions Code)or that he or OYES 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($500).) CODE, SECTION
C M N 25505,
550, 250RTWGD 25534 CONCERNING
❑ 1, as owner of the property, or my employees with wages as their sole
compensation, will do ( ) all of or( ) porting of the work, and the structure is PROPERTY OWNER ORAUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
City of Menifee
Building & Safety Dept.
DEC 2 3 2014
CITY OFMENIFEE PERMIT # qtA-nLA_033-15
BUILDING AND SAFETY DEPARTM ENSece � ,
f 29714 HAUN ROAD, MEN IFEE, CA 925$g'
TELEPHONE: (951)672-6777 DATE:
APPLICATION FOR CERTIFICATE OF OCCUPANCY
PLEASE PRINT LEGIBLY OR TYPE
SECTION I—APPLICANT INFORMATION A�• ^3?3,��1 co L-A
ADDRESS WHERE BUSINESS WILL BE CONDUCTED:
7 $.51 $0-API.6y XOAP.� # 180i M6AJIFE6 , CA97- 5-So
NAME OF BUSINESS: TYPE OF BUSINESS:
A004 rHa,, M_P I IFAJ& "&DtCAf_ OPPU-C-
NAME OF BUSINESS OWNER: BUSINESS PHONE:
AUAJO TOLL ( q!FI ) Riot - olfbo
ADDRESS OF HOME OFFICE OF BUSINESS OWNER: PHONE:
(IF DIFFERENT FROM ABOVE)
OWNER OF BUILDING: ,SAVE PHONE:
SUM PLAZA -509AIC-54 cbN7[-le Lf c- L 951 ) 6 Q—=q;zc�o
ADDRESS: CITY: STATE:
�t� Gt4
DE CRIBE E T USE OF ALL P RTIONS OF EACH BUILDING AND LOT:
AA Eli) tct-
PREVIOUS USE OF BUILDING:
m t.P tc_At_ oar-fcr
SECTION 2-APPLICANT DUTIES
1. Applicant agrees to ensure that the Certificate of Occupancy shall be posted in all businesses,which will
operate subject to the City's issuance of Certificate of Occupancy.
I. AupQ `(t- Q hereby agree to comply with the above-described terms In this Application for
(APPLICANT)
Certificate of Occupancy.
11 � 2w Ito
(APPLICANT) (DATE)
city of Menifee
Building & Safety Dept.
CITY OF MENIFEE DEC Z 3 20I4
Nt BUILDING AND SAFETY DEPARTIVIIO' relved
Tenant Disclosure Form
PERMIT No. Pm-nq-03315
Property Address 23$s( e-oA9 It f80 AA ENrpf=-E , cA R2sa6
Street Name/Number Area/Community zip code
Business name: AUAJq ?HU , MD iNc,
Suite name: # ISO
Occupancy group:
Square footage: 11000
Type of construction: _ s,uc e o
Is the building equipped with fire sprinklers
Number of Employees: 3
Number and location of restroom facilities: 2
s.M t gaIt--9lt�j
List any chemicals used or stored and quantities:
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? No
Are you a new tenant? Na
Are you the first tenant? No
Plans Required:
o 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.
aapPt— A to Tk U t l 2
Signature Print Name Date
Circle One: Tenant / Owner / Contractor / Architect / Engineer