PMT16-00521 City of Menifee Permit No.: PMT16-00521
29714 HAUN RD. Type: Commercial Alteration
<A-CCELh� MENIFEE, CA 92586
MENIFEE Date Issued:
0411 112 01 6
PERMIT
Site Address: 30187 ANTELOPE RD, MENIFEE, CA Parcel Number: 364-010-013
92584 Construction Cost: $75,000.00
Existing Use: Office Proposed Use:
Description of TENANT IMPROVEMENT TO UPGRADE ADA FOR BANK OF AMERICA
Work:
Owner Contractor
WRI GOLDEN STATE FULL CIRCLE MAINTENANCE&CONSTRUCTION
PO BOX 924133 28830 BROKEN ARROW CIRCLE
HOUSTON,TX 77292 MENIFEE, CA 92584
Applicant Phone:9516729992
JACOB WEBSTER License Number:577124
FULL CIRCLE MAINTENANCE&CONSTRUCTION
28830 BROKEN ARROW CIRCLE
MENIFEE, CA 92584
Fee Description Oy Amount ISI
Building Permit Issuance 1 27.00
Reinspections/Additional Inspections 387 387.21
Additional Plan Review Building 194 193.60
GREEN FEE 1 3.00
SMIP COMMERCIAL 1 21.00
$631.81
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
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby off rm under penalty of perjury that I am under provisions of
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 114 License No /L By my signature below I acknowledge that,except for my personal residence
Expires Signature is in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
❑I hereby affirm under penalty of perjury one of the fallowing declarations:I licensed contractors.I understand that a 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 this application is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which
www.leeinfo.ca.aov/calaw.html.
this permit is issued.
Policy# 'Y& -PA 26, '55i / /� Date
❑I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,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 workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: �7� J w application and the Information I have provided is correct.I agree to comply
Carrier 6,Y9/L�—� 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 e6"��'�� enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED 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#
workers compensation la s of Cali ,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers pens Ion pr isions of Section 370 of the Labor
Code,I shall mply cis provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant D ,� mixture containing a hazardous material equal to pr greater that the
amounts spT�o1�f�l�ed on the Hazardous Materials Information Guide?
WARNING:FAILURE TO Si R'S COMPENSA 10 OVE GE IS ❑Yes U
UNLAWFUL,AND SHALL UBIECTAN MPLOYERTO CRIMINAL PENALTIES Will the intended use of the building by the applicant or 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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes DNo
I hereby affirm that under the penalty of perjury there is a construction Will the propo ed building or modified facility be within 10DO feet of the
lending agency for the performance of the work which this permit is issued outer boun ry of a school?
(Section 3097 Civil Code) ❑Yes p
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
perjury j t er hereby affirm under penalty of phat I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the perury )indicated below by the California Health&Safety C Section 25505 and 25534 co cernin9
hazardou a 'alr ort'
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes No l
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 PROP NER O UTHO D 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, PAIR 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 receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an 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 ❑An EPA Lead-Safe Certified Renovator will be 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:
❑I,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 RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
`Menifee
DATE 02/25/2016 PERMIT/PLAN CHECK NUMBER lQ
TYPE: ❑✓ COMMERCIAL ❑RESIDENTIAL MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA [-]SIGN
SUBTYPE: ❑ADDITION [Z]ALTERATION []DEMOLITION ❑ELECTRICAL [—]MECHANICAL
❑NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Tenant improvement-ADA upgrade at existing Bank of America. Pro: i (Ridg and
path of travel,furniture, plumbing fixtures,door pressures and signage.
PROJECTADDRESS 30187 Antelope Rd.
ASSESSOR'S PARCEL NUMBER 36"10-013 LOT TRACT R e C e f Ve
PROPERTY OWNER'S NAME Ica
ADDRESS 2 e to elr�c eta 1 .TA
PHONE (657)378-9641 EMAIL jontel.carter@am.jll.com
APPLICANT NAME Little Diversified-DaMarlon Carter
ADDRESS 1300 Dove St. Suite 100 Newport Beach,CA 92650
PHONE (949)69B-1400 EMAIL dcarter@littleonline.com
CONTRACTOR'S NAME Gary Dixon OWNER BUILDER? ❑YES❑✓NO
BUSINESS NAME Full Circle Maintenance and Construction
ADDRESS 28830 Broken Ar row Circle Menifee,CA 92584
PHONE (951)672-9992 EMAIL gary@fullcirclemaint.com
CONTRACTOR'S STATE LIC NUMBER 577124 LICENSE CLASSIFICATION
VALUATION$ $75.000.00 S L SO FT
APPLICANT'S SIGNATURE DATE 02/25/2016
CITY�TrAiFF USE ONLY
DEPARTMENT DISTRIBUTION ��11 CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP pi�
INVOICE I 1 i PAID AMOUNT G
AMOUNT 61 5 O CASH :'CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH O'CHECK# OCREDITCARD VISA/MC
OWNER BUILDERVERIFIED OYES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityc finenifee.us Inspection Request Line 951-246-6213