PMT15-02850 City of Menifee Permit No.: PMT15-02850
29714 HAUN RD.1 CCEL// MENIFEE, CA 92586 Type: Commercial Alteration
MENIFEE Date Issued:
10113/2015
PERMIT
Site Address: 30141 ANTELOPE RD, Suite#J, Parcel Number: 364-010-009
MENIFEE,CA 92584 Construction Cost: $0.00
Existing Use: Proposed Use:
Description of HOURLY INSPECTION FOR C OF 0"H& R BLOCK"
Work:
Owner Contractor
WRI GOLDEN STATE LLC
PO BOX 924133
HOUSTON,TX 77292
Applicant License Number:
MENIFEE,CA
Fee Description gyt Amount ISI
Building Permit Issuance_ __` 1 _ 27.00
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 carded 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_Blog_Pennit_Template.rpt Page 1 of 1
DATE �1�j'�5 PERMIT NUMBER k? IM t
BUSINESS NAME H&R Block c TYPE OF BUSINESS 1Tax Prep Svcs
ADDRESS�W� r� �'' Cc .� 5 I� rp �rF�3 CtA. Gas— t4
NAME OF BUSINESS OWNER(S)_ HRB Tax Group Inc.
Att: Business License 1
ADDRESS(IF DIFFERENT FROM ABOVE)_ One H & R Block Way
PHONE (816)759-0002 Kansas City, MO PAIR5 OCOEBusinessLicense@hrblock.com
OWNER OF BUILDING , ``
ADDRESS �C Uw A o �\-e c Q C i �)c
PHONE C�t0-�J�� - �'ID EMAIL
DESCRIBE EXACT USE OF BUILDING: Tax Prep Svcs
j
C PREVIOUS USE OF BUILDING/SUITE H&R Block Tax Prep Svcs
APPLICANT ACKNOWLEDGEMENT
Applicant agrees that the Certificate of Occupancy shall be posted in a conspicuous location,and will operate subject
to(the
\City's iss nc�e ofth�e,Certificate of Occupancy.
,( i �°`�—� hereby agree to comply with the above-described terms in this
FApplication for Certificate of Occupancy.
v
Licensing & Tax ecialist DATE 1 4 1 S
` APPLICANT�l is� i� �F'� a �!�('• . •, o as t. .d aii,'° �a a. ����j�FSl�S} b' _ � M' d.�"x� ..
LVI BUS LICENSE DATE ENGINEERING DATE
BUS LIC.NUMBER FIRE DATE
PLANNING DATE EMWD DATE
HEALTH DEPT DATE BUILDING DATE
REMARKS
City ofIUC'illj P2. f3U1l(flf7(] $'i/F r4 n<J)GI'tiRPHt 29714 Htillll R7. ( 7l((. ', t.A
rCR (.'i.i ;[ !e
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ADDRESS Aec
BUSINESS NAME H&R Block
INTENDED BUSINESS USE Tax Prep Svcs
IS THIS A NEW BUSINESS IN THE CITY OF MENIFEE? YES �^ (CIRCLE ONE)
ARE YOU THE FIRST TENANTTO OCCUPY THIS SPACE? YES 'L (CIRCLE ONE)
IS THE BUILDING EQUIPPED WITH FIRE SPRINKLERS? YES NO (CIRCLE ONE)
SQUARE FOOTAGE
NUMBER OF EMPLOYEES
NUMBER AND LOCATION OF RESTROOM FACILITIES
LIST ANY TOXIC CHEMICALS, FLAMMABLE/COMBUSTIBLE LIQUIDS OR GASES USED OR STORED WITH
MSDS SHEETS AND QUANTITIES OF EACH BELOW OR ON A SEPARATE ATTACHED SHEET(S):
7�
• ARE YOU MAKING ANY IMPROVEMENT TO THE SUITE OR BUILDING OTHER THAN PAINTING,
�i PAPERING, FLOOR COVERING, MOVABLE CASES, SHELVING OR PARTITIONS NOT 025,9" HIGH?
YES `(S��I (CIRCLE ONE)
• APPLICANT SHALL OBTAIN ALL REQUIRED CLEARANCES AND/OR APPROVALS FROM THE
(r APPROPRIATE WATER DISTRICT AND FIRE DEPARTMENT PRIOR TO ISSUANCE OF ANY
y BUILDING PERMITS
SIGNATURC�N, ` \ DATE
J PRINT NAME —C_ Licensing & Tax Specialist
`II TENANT / OWNER / CONTRACTOR / ARCHITECT / ENGINEER (CIRCLE ONE)
V
FOR CITY STAFF PERMIT NUMBER
rvcl I OCCUPANCY GRP TYPE OF CONST STAFF INITIALS