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PMT16-00374 City of Menifee Permit No.: PMT16-00374 29714 HAUN RD. Type: Commercial Alteration �f�CCELA-> MENIFEE,CA 92586 MENIFEE Date Issued: 02/12/2016 PERMIT Site Address: 27134 SHADEL RD, MENIFEE, CA 92586 Parcel Number: 333-030-016 Construction Cost $0.00 Existing Use: Proposed Use: Description of HOURLY INSPECTION FOR CERTIFICATE OF OCCUPANCY-CHANGE OF OWNERSHIP FOR Work: "SPEEDY SMOKE SHOP#A" Owner Contractor BEL-AIR PLAZAICAL AM PROPERTIES FATHER'S AND SON'S CORP 27100 SHADEL RD 27134 SHADEL RD MENIFEE,CA 92586 MENIFEE,CA 92586 Applicant Phone:9515387010 FATHER'S AND SON'S CORP License Number. 16-PEOP-00007 27134 SHADEL RD MENIFEE,CA 92586 Phone: 9515387010 Fee Description QQtt t Amount isl 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_Bldg_Permit_Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects I herebyaffirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractors State License Law for Professions Code and my license is in full force and effect. the following reason: License class License No. By my signature below I acknowledge that,except for my personal residence Expires Signature In which I must have resided for at least one year prior to completion of WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I have built as an owner-builder if it has not been constructed in its entirety by ❑1 hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that copy of the applicable law,Section have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Code,is available upon request when compensation,issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code,for the performance of work for which this application is submitted or at the following website: this permit is issued. www.leginfo.ca aov/calaw html. Policy# Date ❑I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Cade,for the performance of the work for which ❑By my signature below I certify to each of the following:I am the property this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this numberare: application and the information I have provided is correct.I agree to comply Carrier with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy# Expires enter the above identified proper a 'nspection purposes. (This section need not to be completed is the permit is for one-hundred dollars($100)or less Date PROPERTY W ORIZED AGENT ❑I certify that in the performance of the work for which this permit is issued, I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# worker's compensation laws of California,and agree that if I should become subject to the workers compensation provisions of Section 3700 of the Labor HAZARDOUS MATERIAL DECLARATION Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant Date mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN Will the intended use of the building by the applicant or future building ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist for guidelines CONSTRUCTION LENDING AGENCY ❑Yes ❑No I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the lending agency for the performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) ❑Yes o No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting. Business and Professions Code).Any city or county that requires a permit to OYes ❑No construct,alter,improve,demolish or repair any structure,prior to its Date issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRP) License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt from liwnsure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint in a pre-1978 an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to be RRP-certified firms and comply with than($500), required practices.This includes rental propertyowners and property managers who do the paint-disturbing work themselves or through their ❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.eov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323). Code,The Contractor's State License Law does not apply to an owner of a property who,through employees'or personal effort,builds or improves the O An EPA Lead-Safe Certified Renovator will be responsible for this project property provided that the improvements are not intended or offered for Certified Firm Name: 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 Firm Certification No.: not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project bemuse: ❑I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement. ERTIFICATE OF OCCUPANCY • a ; TENANT , • • APPLICATION vi Menifee DATE BUSINESS NAME sm—w `� BUSINESS ADDRESS • `- \\ NAME(S) OF BUSINESS OWNERSeCS PHONE NUMBER Ck \— EMAIL �( t(�CLC�I Z l� YICL•( OWNER OF BUILDING (-rN-\ wy\ 6- \QS OWNER OF BUILDING ADDRESS \'(\0k\ cLL 'Z INTENDED BUSINESS USE 4 SC-o IS THIS A NEW BUSINESS IN THE CITY OF MENIFEE? ( NO (CIRCLE ONE) ARE YOU THE FIRST TENANT TO OCCUPY THIS SPACE? YES NO (CIRCLE ONE) IS THE BUILDING EQUIPPED WITH FIRE SPRNKLERS? YES NO (CIRCLE ONE) SQUARE FOOTAGE I /SD NUMBER OF EMPLOYEES NUMBER AND LOCATION OF RESTROOM FACILITIES /J • J W ildi 1q , ES• LIST ANY TOXIC CHEMICALS, FLAMMABLE/COMBUSTIBLE LIQUIDS OR GAS USED OR �J STORED WITH MSDS SHEETS AND QUANTITIES OF EACH BELOW OR ON A SEPARATE ATTACHED SHEET(S): • ARE YOU MAKING ANY IMPROVEMENTS TO THE SUITE OR BUILDING OTHER THAN PAINTING, PAPERING, FLOOR COVERING, MOVABLE CASES, SHELVING OR PARTITIONS NOT OVER 5' 9" HIGH? YES NO (CIRCLE ONE) Applicant agrees that the Certificate of Occupancy shall be posted in a conspicuous ocation, and will operate subject to the City' issuance of the Certificate of Occupancy. tY I, eJ ' C'N � hereby agree to comply with the above- described terms in this Application of cupancy. SIGNATURE DATE APN ( OI PERMIT NUMBER f7tA 1T�� INVOICE AMOUNT `t� ��Ou� r�� OCCUPANCY GROUP City of Menifee Building& Sofety Department 29714 HOLM Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213