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PMT16-00576 City of Menifee Permit No.: PMT16-00576 29714 HAUN RD. Type: Commercial Alteration -i;kCCELAA7 MENIFEE,CA 92586 MENIFEE Date Issued: 03104/2016 PERMIT Site Address: 26B30 CHERRY HILLS BLVD, MENIFEE, Parcel Number: 337-320-016 CA 92586 Construction Cost: $0.00 Existing Use: Proposed Use: Description of HOURLY INSPECTION FOR CERTIFICATE OF OCCUPANCY FOR"THE CONCERN, INC." Work: Owner Contractor CHERRY HILLS PLAZA, LLC THE CONCERN, INC 26834 CHERRY HILLS BLVD 26830 CHERRY HILLS BLVD MENIFEE, CA 92586 MENIFEE,CA 92586 Applicant Phone:9516792374 CECILIA BURCH License Number: 16-PEOP-00010 THE CONCERN, INC 26830 CHERRY HILLS BLVD MENIFEE, CA 92586 Phone:9516792374 Fee Description Qtv Amount M Building Permit Issuance 1 27.00 Inspections not specified 129 129.07 General Plan Maintenance Fee-Building 1 6A5 $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 hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law). Chapmr9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from Iicensum 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 l 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 following 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 workers 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.eov/calaw.html. this permit is issued. Policy# Date O 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 o By my signature below I certify to each of the following:1 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 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 ent the above identified op b for inspection purposes. (This section need not to he completed is the permit is for one-hundred c-r Date dollars($100)or less p PERTY 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 laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or 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 15 ❑Yes o No UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building AND CNIL 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 forguidelines 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 ❑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 Contractors 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 Date construct,alter,improve,demolish or repair any structure,prior to its PROPERTY 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(RRPJ 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 ❑1,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.00v/lead or contact the National Lead Information Center at not Intended or offered for sale.(Section 7044,Business and Professions 1-80D-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: ❑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 RRP rule please fill out the RRP Acknowledgement. CERTIFICATE OF OCCUPANCY & TENANT DISCLORE APPLICATION blMenifee DATE c3 BUSINESS NAME ' �T BUSINESS ADDRESS C . J 1-0 0- EA)1 C—QZs$6 NAME(S)OF BUSINESS OWNERS Coal A- Q u 2C',q p-F-Sl ) iPAR- PHONE NUMBER qsr - 6'7 q -9-3')q EMAIL `7 Ae-Cow-ern r n e.90oo.COM OWNER OF BUILDING p,1H ILL-.5 /n L r, aA- LL-C, OWNER OF BUILDING ADDRESS a/0 W3 q C14 FU N I/LL6 41-VP- MHU FeE q26% INTENDED BUSINESS USE IUONPRDF GOI ZZ1�no ) IS THIS A NEW BUSINESS IN THE CITY OF MENIFEE? YES NO (CIRCLE ONE) ARE YOU THE FIRST TENANT TO OCCUPY THIS SPACE? YES N (CIRCLE ONE) IS THE BUILDING EQUIPPED WITH FIRE SPRNKLERS? YE NO (CIRCLE ONE) Or SQUAREFOOTAGE d/a0 NUMBER OF EMPLOYEES NUMBER AND LOCATION OF RESTROOM FACILITIES I - bLI. Ot'— 4 • LIST ANY TOXIC CHEMICALS, FLAMMABLE/COMBUSTIBLE LIQUIDS OR GASES USED OR STORED WITH MSDS SHEETS AND QUANTITIES OF EACH BELOW OR ON A SEPARATE ATTACHED SHEET(S): IJ oA) E • 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 (CIRCLEONE) Applicant agrees that the Certificate of Occupancy shall be posted in a conspicuous location,and will operate subject to the City' issuance ofAthe Certificate of Occupancy. C- C eov`I, C � u A ' V hereby agree to comply with the above- described terms' this Application of if' a e of Occupancy. /! SIGNATURE DATE `7 CITY STAFF USE ONLY APN 1 15aO- D PERMITNUMBER INVOICEAMOUNT tt40;k,5a' OCCUPANCY GROUP City of Menifee Building& Safety Department 29714 Haun Rd. 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