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PMT16-00892 City of Menifee Permit No.: PMT16-00892 29714 HAUN RD. �/ACCELA-'? MENIFEE,CA 92586 Type: Commercial Alteration MENIFEE Date Issued: 03/28/2016 PERMIT Site Address: 28071 BRADLEY RD, MENIFEE, CA Parcel Number: 337-302-009 92586 Construction Cost: $0.00 Existing Use: Office Proposed Use: Description of HOURLY INSPECTION FOR CERTIFICATE OF OCCUPANCY FOR"SERENDIPITY HEARING INC" Work: Owner Contractor SERENDIPITY HEARING INC 28071 BRADLEY RD MENIFEE, CA 92586 Applicant Phone:7148985732 MLLARD GILILLANND License Number: 16-PEOP-00013 28071 BRADLEY RD MENIFEE,CA 92586 Phone: 7148985732 Fee Description Qtv Amount l$I Building Permit Issuance 1 27.00 Inspections not specified 129 129.07 $156.07 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 building 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 peril 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). Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's 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 1 acknowledge that,except for my personal residence Expires Signature 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 o I 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 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 If Date ❑I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the labor Code,forthe 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 number are: 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 troo . orrcti a representatives of this city or county to Policy if Expires enter a hove' ified property for inspection purposes. (This section need not to be Completed is the permit is for one-hundred / Date dollars($100)or less OPERry r ER THO [ZED AGENT ❑I certify that in the performance of the wads for which this permit is issued, I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS U ENSE If workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the worker's 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 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 15 ❑Yes ❑No UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO 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 ❑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 permitting checklist I understand my requirements under the State of I hereby affirm under penalty of perjury that I am exempt from the California Contractor's License law for the reason(s)indicated below by the hazardous Health al Safety Code,Section 25505 and 25534 concerning u hazzardou checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hs material reporting. Business and Professions Code).Any city or county that requires a permit to OYes ❑No Dale 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRPI Ucense 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-1918 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.epa.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 D 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. City of Menifee F3Llilding & Safety Dept. MenifeeMAR 28 2016 DATE 03/2016 PERMIT NUM E e �V. r ADDRESS 28071 Bradley Road Sun City,CA 92586 BUSINESSNAME Serendipity Hearing Inc. INTENDED BUSINESS USE IS THIS A NEW BUSINESS IN THE CITY OF MENIFEE? YES 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) SQUAREFOOTAGE 1 � NUMBER OF EMPLOYEES 4 NUMBER AND LOCATION OF RESTROOM FACILITIES 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): ' 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 'M (CIRCLE ONE) • APPLICANT SHALL OBTAIN ALL REQUIR ARANCES AND/OR APPROVALS FROM THE APPROPRIATE R DISTRICT AN IRE D PARTMENT PRIOR TO ISSUANCE OF ANY BUILDING P MITS SIGNATURE DATE 3/22/2016 PRINTNAME Willard Gilliland TENANT / OWNER / CONTRACTOR / ARCHITECT/ ENGINEER (CIRCLE ONE) OCCUPANCY GRP TYPE OF CONST STAFF INITIALS City of Menifee Building& Safety Deportment 29714 Howl Rd. Menifee, CA 92586 951-672 6777 r www.cityofinenifee.us Inspection Request Line 951-246-6213 ;AAA, F OCCUPANCY APPLICATION q 1 City of Menifee Building & Safety Dept. Menifee MAR 28 201b DATE 3/22/2016 PERMITNUMBER BUSINESS NAME serendipity Hearing Inc. TYPE OF BUSINESS Coroporation ADDRESS 28071 Bradley Road Sun City,CA 92586 NAME OF BUSINESS OWNER(S) Willard Gililland-CEO and Loren Lunsford-Prescient ADDRESS(IF DIFFERENT FROM ABOVE) 5882 Bolsa Ave Ste.130 Huntington Beach,CA 92649 PHONE (714)898-5732 EMAIL OWNER OF BUILDING Prime Properties ADDRESS 29826 Haun Road Ste.305 Menifee,CA 92586 PHONE EMAIL DESCRIBE EXACT USE OF BUILDING: Office use for hearing aids and services. PREVIOUS USE OF BUILDING/SUITE SAME 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. Willard Gilliland ereby agree to comply with the above-described terms in this j Application MCupa y. j DATE 31 ZZ 1 1 APPLICA BUS LICENSE DATE ENGINEERING DATE BUS LIC.NUMBER FIRE DATE PLANNING DATE EM W D DATE HEALTH DEPT DATE BUILDING DATE REMARKS City of Menifee 8uildina& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 wwW.cityofinenifee.us Inspection Request Line