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PMT16-00469 City of Menifee Permit No.: PMT16-00469 29714 HAUN RD. Type: Commercial Alteration <ACCEL/-> MENIFEE, CA 92586 `......""`" MENIFEE Date Issued: 0610V2016 PERMIT Site Address: 30131 HAUN RD, MENIFEE, CA 92584 Parcel Number: 360-080-034 Construction Cost: $57,000.00 Existing Use: Proposed Use: Description of INSTALL HIGH PILE RACKING 12,296 SQ FT Work: Owner Contractor PETSMART W T D HOLDINGS INC 19601 N 27TH AVE 2255 JUSTIN TRAIL PHOENIX,AZ 85027 ALPHARETTA, GA 30004 Applicant Phone:7704081272 NATIONWIDE PERMITTING License Number.92460E CA Fee Description Qtv Amount is) Building Permit Issuance 1 27.00 Additional Plan Review Building 394 393.75 GREEN FEE 1 3.00 SMIP COMMERCIAL 1 19.00 New Construction Permit Fee 1 308.20 General Plan Maintenance Fee-Building 1 0.00 General Plan Maintenance Fee-Mechanical 1 0.00 General Plan Maintenance Fee-Plumbing 1 0.00 General Plan Maintenance Fee-Electrical 1 0.00 General Plan Maintenance Fee-New 1 15.41 Construction $766.36 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 sidg_Permit_Template.rpt Page 1 of 1 CITY OF MENIFEE ICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects I hereby affirm under penalty of perjurythat 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 o I am exempt from licensure under the Contractor's State License taw for Professions Code and my license is in full force and effect. the following reason: License Clas �� ense No. "l Z k(0 g By my signature below I acknowledge that,exceptfor my personal residence l� Expires l� 'Stgna in which I must have resided for at least one year prior to completion of F.e RKER'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 hereby affirm under penalty of perjury one of the fallowing declarations:I licensed contractors.I understand that a copy of the applicable law,Section e 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 pensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website: Section 3700 of the Labor Code,for the performance of work for which permit issued. ''77 q^ �+ www.leeinfo.ca.eov/calaw.html. icy# W C LA �2- l y 7 1 5 7 is Date have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT ion 3700 of the Labor Code,for the performance of the work for which o By my signature below I certify to each of the following:I am the property permit Is Issued.My workers compensation insurance carrier and policy owner or authorized to act an the property owners behalf.I have read this ber are: 1, _ application and the information 1 have provided is correct.I agree to comply rier IV I'c�� `��kOL7 �'� with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to ty# (A)�J0 A0'71»XExpires (o\�� 'Zc7t Io enter the above identified property for inspection purposes. is section need not to be completed is the permit is for one-hundredDate ars($100)or less PROPERTY OWNER OR AUTHORIZED AGENTertify that in the performance of the work for which this permit is issued, 07 14O% #not-emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# -Jkers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION ect to thew kers compensation provisions of Section 370 o the Labor e,lshallfa h ltth comply with those provisions. Will the applicant or future building occupant handle hazardous material ora lic !\ Date (P � � mixture containing a hazardous material equal to or greater that the amounts,sI`p,e,�cified on the Hazardous Materials Information Guide? RNING:FAIL TO SECURE WORKER'S COMPENSATION C VERAGE IS D Yes 7"" UNLAWFUL,AND SHALLSUBIECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicantor future building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAOMD)75ee permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo Coast Airlines Qua CONSTRUCTION LENDING AGENCY D Yes !o 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 bound ry of a school? (Section 3097 Civil Code) D Yes Jo OWNER BUILDER DECLARATIONS I have read the Hazardous MaterlaI Information Guide and the SCAOMD I hereby affirm under penalty of perjurythat I am exempt from the permittingPalth& I understand my requirements under the State of California fety Code,Section 25505 and 25534 concerning Contractors License Law forthe reasons)indicated below by the haz dournia rung. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 s o Business and Professions Code).Any city or county that requires a permit to Date construct,alter,improve,demolish or repair any structure,prior to its OPERTY OWNER OR AUTHORIZED AGENT issuance,also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRP) License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors Business and Professions Code)or that he or she is exempt from licensure most work that disturbs paint In a pre-]978 mo for and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare receiving compensation forfacili mo he RRP-certified firms and comply with than Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property than($500). 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 Contractors State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will 6e responsible for this project property who,through employees'or personal effort,builds or improves the 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 Firm Certification No.: completion,the Owner-Builder will have the Burden of proving that it was not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because: ❑1,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RAP rule please fill out the RRP Acknowledgement. WTD Holdings, Inc. 2255 Justin Trail,Alpharetta, GA 30004 770-408-1272 ty of Menifee May 31, 2016 & Safety Dept. ;�;iJ 0 1 2016 eceived To whom it may concern: I, Clinton Alan Darnell, hereby authorize Ohmar Villavicencio and Brandon Faulk to pick up permit PMTl6-00469 for the PetSmart project from the City of Menifee,CA on behalf of WTD Holdings, Inc. and myself. Sincerely, Clinton Alan Darnell Certified Contractor: WTD Holdings, Inc. License Class: B General Building Contractor&D24 Metal Products License Number: 924608 Qualifying Agent's Name: Clinton Alan Damell Address: 2255 Justin Trail,Alpharetta, GA 30004 Phone:770-408-1272 Witnessed this day by: ••••;GATLIN��0,0 G'EURGIA ZG) wxu+23•2M O» (��( jug