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PMT16-00004 City of Menifee Permit No.: PMT16-00004 29714 HAUN RD. rACCELA? MENIFEE,CA 92586 Type: Commercial Alteration MENIFEE Date Issued: 01/04/2016 PERMIT Site Address: 26025 NEWPORT RD,Suite#A, Parcel Number: 360-011-027 MENIFEE,CA 92584 construction Cost: $0.00 Existing Use: Proposed Use: Description of HOURLY INSPECTION FOR CERTIFICATE OF OCCUPANCY FOR"THE UPS STORE"UNDER NEW Work: OWNERSHIP Owner Contractor ARYA NEWPORT CROSSING THE UPS STORE 2603 MAIN ST#210 154 A W FOOTHILL BLVD#900 IRVINE,CA 92614 UPLAND,CA 91786 Applicant Phone:9099217079 SCOTT&DENISE FORREST License Number. 16-PEOP-00001 THE UPS STORE 154-A W FOOTHILL BLVD#900 UPLAND,CA 91786 Phone:9099217079 Fee Description Qtv Amount 1E1 Building Permit Issuance 1 27.00 Inspections not specified 129 129.07 General Plan Maintenance Fee-Building 1 6.45 $162.52 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_BIdg Permit_Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ 1 am exempt from licensure under the Contractors'State License Law for the 1 hereby affirm under penalty or perjury that I am licensed under provisions of following reason: 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. improvements covered by this permit, I cannot legally sell a structure that I have Expires Signature built as an owner-building if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7D44 of the WORKERS'COMPENSATION DECIARATION 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: htto://www.leainfo.ca.acv/calaw.html. 1 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 Labor 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 carder and policy number are: with all applicable city and county ordinances and slate laws relating to building construction.I authorize representatives of this city or county to enter the above- Carrier identified p rty r the i spection purposes. Policy# Expires Dale Prope er or Authorized Agent (This section need not be completed if the permit is for City Business License# one-hundred dollars($100)or less) ❑ 1 certify that in the performance of 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 specified on the Hazardous Materials Information Guide? Code,I shall forthwith comply with those provisions. ❑YES ❑NO Applicant; Dale; Will the intended use of the building by the applicant or future building occupant require a permit for the construction or modification from South WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAOMD)?See permitting checklist COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES ❑NO 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 ❑ NO 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 lending permitting checklist.I understand my requirements under the State of agency for the performance of the work which this permit is issued (Section California Health&Safety Code,Section 25505 and 25534 concerning 3097 Civil Code) hazardous material reporting. OWNER BUILDER DECLARATIONS DYES ❑NO 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 checkmadr(s)I have placed PROPERTY OWNER 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(RRP) 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 property 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 EPKs Renovation Program visit: www.epa.gov/lead or contact the National Lead Information Center at ❑ 1, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(5323). compensation,will do( )all of or( )parting of the work,and the structure is 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 ❑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 Finn 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 Firm 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 ArJ,nn.I.A.Pmant CERTIFICATE OF OCCUPANCY APPLICATION ' ` `Menifee i DATE I� 9 PERMIT NUMBER �y OOVO4 BUSINESS NAME l Y\Q �� PS C) ClI pgND TYPE OF BUSINESS cS�IDQl111a L �P�L1 I ADDRESS NAME OF BUSINESS OWNER(S) �� C(0� 4,-\- D(��i111(St. in��^�r/n�'\j— QI/ ADDRESS(IF DIFFERENT FROM ABOVE) 15 N-A \N •"T7'�t7i Al I I N I)AW 0I I�.I/In S La �1 1 191 PHONE �IICI �� —7Z)7 7 EMAIL 11Lr .1 \P. �InO eW cc)'(l OWNER OF BUILDING C \)�A i� e �DoC A- C_ C-0 s I� 1/ ,LC / ADDRESS �2&r, '? r S A- Skr_ d'(OI r ro I\-e Cei PHONE 3TCf /7 G EMAIL DESCRIBE EXACT USE OF BUILDING: \J IDS j)nslh I\ PREVIOUS USE OF BUILDING/SUITE U �e_ 74 APPLICANT ACKNOWLEDGEMENT Applicant agrees that the Certificate of Occupancy shall be posted in a conspicuous location,and will operate subject to the City's issuance of the Certificate of Occupancy. I, b,Pn l4>& , hereby agree to comply with the above-described terms in this Application for Certificate of Occupancy.� > � :�L,"'��qI DATE I ' tl' lCy APPLICANT BUS LICENSE DATE ENGINEERING DATE BUS LIC.NUMBER FIRE DATE PLANNING DATE EMWD DATE HEALTH DEPT DATE BUILDING DATE REMARKS City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line CERTIFICATEOF OCCUPANCY TENANT • • ' Menifee DATE `- l(- �� PPERMITNUMBER ADDRESS -'16 0 aJ N ew 'r �( cj BUSINESS NAME INTENDED BUSINESS USE y, IS THIS A NEW BUSINESS IN THE CITY OF MENIFEE? YES (CIRCLE ONE) ARE YOU THE FIRST TENANT TO OCCUPY THIS SPACE? YES (CIRCLE ONE) ISTHE BUILDING EQUIPPED WITH FIRE SPRNKLERS? YES NO (CIRCLE ONE) SQUARE FOOTAGE Cj b NUMBER OF EMPLOYEES NUMBER AND LOCATION OF RESTROOM FACILITIES LISTANYTOXIC CHEMICALS, FLAMMABLE/COMBUSTIBLE LIQUIDS OR GASES USED OR STORED WITH MSDS SHEETS AND QUANTITIES OF EACH BELOW OR ON A SEPARATE ATTACHED SHEET(S): • ARE YOU MAKING ANY IMPROVEMENT TO THE SUITE OR BUILDING OTHER THAN PAINTING, PAPERING, FLOOR COVERING, MOVABLE CASES,SHELVING OR PARTITIONS NOT OVER 5'9" HIGH? YES (�!:) (CIRCLE ONE) • APPLICANT SHALL OBTAIN ALL REQUIRED CLEARANCES AND/OR APPROVALS FROM THE APPROPRIATE WATER DISTRICT AND FIRE DEPARTMENT PRIOR TO ISSUANCE OF ANY BUILDING PERMITS SIGNATURE I E , � - DATE PRINT NAME D r NANT / OWNER / CONTRACTOR / ARCHITECT/ ENGINEER (CIRCLE ONE) OCCUPANCY GRP TYPE OF CONST STAFF INITIALS City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 \f� �-.,� • � • ,ant , r � s • v k r \ 4 � f