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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