PMT15-02935 City of Menifee Permit No.: PMT15-02935
29714 HAUN RD.
4F►C A—> MENIFEE,CA 92586 Type: Commercial Alteration
MENIFEE Date Issued: 11/19/2015
PERMIT
Site Address: 30080 HAUN RD,Suite#P2, MENIFEE, Parcel Number: 360-690-007
CA 92584 Construction Cost: $227,984.40
Existing Use: Proposed Use:
Description of DIVIDE EXISTING 4,980 SQ FT SUITE INTO 2 SUITES, LENS CRAFTERS(STE 350)3,000 SQ FT
Work: AND"DOG HOUSE"(STE 360)1,980 SQ FT
Owner Contractor
DONAHUE SCHRIBER JASON WELCH
5694 MISSION CENTER ROAD 1340 WATSON AVENUE
SAN DIEGO,CA 92108 COSTA MESA, CA 92626
Applicant Phone: 9492307945
MENIFEE,CA License Number.904363
Fee Description Qtv Amount l$)
Services, Switchboards, Control Centers&Panels 1 183.00
Services, Switchboards, Control Centers&Panels 1 283.00
Receptacle, Switch, Outlet&Fixture 6 141.00
Forced-Air or Gravity-Type Furnace or Burner 2 298.00
Air Handling/Condensing Units Non-SFR 2 366.00
Building Permit Issuance 1 27.00
Administrative Fee 148 148.37
Additional Plan Review Building 270 270.00
Additional Plan Review Building 45 45.00
GREEN FEE 1 10.00
SMIP COMMERCIAL 1 64.00
New Construction Permit Fee 1 1,048.73
General Plan Maintenance Fee-Mechanical 1 33.20
General Plan Maintenance Fee-Electrical 1 30.35
General Plan Maintenance Fee-New 1 52.44
Construction
$3,000.09
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_Pernit_Template.rpt Page 1 of 1
City Of Menifee
ICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'State License Law for the
following reason:
hereby affirm under penalty or perjury that I am licensed under provisions of -
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that,except for my personal residence in
Professions Code and my license Is in full force and effect. which I must have resided for at least one year prior to completion of
License Class License No. 3 improvements covered by this permit, I cannot legally sell a structure that I have
Expires U3 3 1 17 Signature v built as an owner-building if It has not been constructed in its entirely by licensed
contractors. I understand that a copy of the applicable law,Section 7044 of the
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application is
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: hftc://w m.leginfo.ca.ciov/mlaw.htmi.
I have and will maintain a certificate of consent of self-Insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the property
❑ 1 have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read this
section 3700 of the tabor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comply
permit is issued.My workers'compensation insurance carrier and policy number are: 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-
Carrier identified property for the inspection purposes.
Policy# Expires Date
Property Owner or Authorized Agent
(This section need not be completed if the permit is for City Business License#
one-hundred dollars($100)or less)
I certify that in the performanceof the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers'compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts s ecified on the Hazardous Materials Information Guide?
Code,I shall forthwith comply with those provisions. c ❑YES 1NO
Ap IlcanY Date; � ) ( � ( J Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARN G: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES EAO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES Echo
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lendin permitting checklist.I understand my requirements under the State of
agency for the performance of the work which this permit is issued (Sectio California Health&Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardousTaterial reporting.
OWNER BUILDER DECLARATIONS DYES fJ NO/y/
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date
License Law for the reason(s)indicated below by the checkmark(s)I have placed PERTpOWNER OR AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5. Business and Professions Code:
Any city or county that requires a permit to construct,alter,improve, demolish, EPA RENOVATION,REPAIR AND PAINTING IRRPI
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 The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law(Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and properly
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPNs Renovation Program visit:
www.epa.gov/lead or contact the National Lead Information Center at
❑ I, as owner of the property, or my employees with wages as their sole 1-80D-424-LEAD(5323).
compensation,will do( )all of or( )porting of the work,and the structure is
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractors State License Law does not apply to an owner of a property ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees'or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name:
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 Firm Certification No.:
purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Finn is required for this project because:
contractors to construct the project(Section 7044, Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
Ar4nnwiudncmcnt
Riverside County Fire Department It
Fire Protection Planning Section
Rry WeOffice:23001.1akel Sr.Sle.150,Rx,emide.c1925a1 Ph(9511 9 5 5-4121 Fax(95s)955d986
Palm Desert OPxe: 27-933 Las Mosaahas Rd..v 201Pa1m Desen,[A 9221 ba131 Ph.(260)863,8806 Fax(7601863 7022
Fire Department Clearance/Release
Date:
To: ccarlson(a)citvofinenifee.us brivera(a)citvofinenifee us mbinnall(a)citvofinenifee us
Fax:
Tract/Parcel Map#: t MY;I�t1-1) {�PermiULot#: (
Job Site Address: a0 h ) U;n U
,.01 I
rl Final For Recordation
Release For Building Permit(s)
0 Shell Final Only(No Tenant)
171 Final For Occupancy
( l Release For Residential Sprinkler Installation
Building Plan Check Fees Paid,Water Requirement Met-if waterapplicable
rl Building Plan Check Fees Not Paid
rl Residential Sprinkler Plan Check Fees Paid
rl Residential Sprinkler Plan Check Fees Not Paid
rl Other Fees
0 Fees Not Required
If you should have any questions, please contact the appropriate Riverside County Fire Protection Planning office for
further assistance. � � 41. ;=. S S
Print Name of Plan Reviewer/Inspector Approved Release
Sent By:Printhame
Form C—Revised Wi i2012