PMT16-00926 City of Menifee Permit No.: PMT16-00926
29714 HAUN RD.
�CCELA—? MENIFEE, CA 92586 Type: Sign-Permanent
MENIFEE Date Issued:
03/29I2016
PERMIT
Site Address: 30340 HAUN RD, MENIFEE, CA 92585 Parcel Number: 360-690-021
Construction Cost: $1,020.00
Existing Use: Proposed Use:
Description of INSTALL NEW CHANNEL LETTER SIGN"CVS PHARMACY"
Work:
Owner Contractor
TARGET CORP ICON IDENTITY SOLUTIONS INC
1000 NICOLLET MALL 1418 ELMHURST ROAD
MINNEAPOLIS, MN 55403 ELK GROVE VILLAGE, IL 60007
Applicant Phone:8473642250
CHRIS KELLEY License Number. 796721
ICON IDENTITY SOLUTIONS INC
1418 ELMHURST ROAD
ELK GROVE VILLAGE, CA 60007
Fee Description QtV Amount ISl
Sign Permit 1 190.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 9.50
$227.50
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_Permk Template.rpt Page 1 of 1
CITY OF MEN IFEE
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 Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class Gyf License No. 9 7 2 I By mysignature below I acknowledge that,except for my personal residence
Expires (a_3 O- I.7 Signature C �� 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 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 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 ,�,ww,leeinfo.ra.eov/caiaw.html.
this permit is issued.
Policy If
Date
'a-t have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,forthe performance of the workfor 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 owners behalf.I have read this
number are/�: II __ application and the information I have provided is correct.I agree to comply
ws
Carrier /IMOn,6'An/ 4 Mcr.1- t with all applicable city and county ordinances and state la relating to
building construction.I authorize representatives of this city or county to
Pollcyrik,!=c-?2.`7gt Expires -4 -2Id -1 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 tl
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 a
Applicant G +� �—Date 3 (o 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 SUBIECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDREDTHOUSAND 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(SCACLMD)?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
permitting checklist I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the
California
Contractors License Law for the reason hazzardou
s)indicated below by the Health al Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 DYes ❑No
Business and Professions Code).Any city or county that requires a permitto Date
construct,alter,Improve,demolish or repair any structure,priorto 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(RRPI
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-certfied 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 sale 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.Rov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-SOD-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 3 '99'a0/6, PERMIT/PLAN CHECK NUMBER gknLu - 00CFV-QLO
TYPE: [-]COMMERCIAL ❑RESIDENTIAL MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA(Q SIGN
SUBTYPE: []ADDITION []ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑ MECHANICAL
❑NEW ❑PLUMBING El RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Install illuminated channel letters and logo 23 3/8"h x 18'3 15/16"w //DVS 'P�4e II
PROJECTADDRESS 30340 Haun Rd
ASSESSOR'S PARCEL NUMBER ?j(O(2 - IiQf,__, -naL \ LOT TRACT
PROPERTY OWNER'S NAME Target Corporation 4 Of Menifee 1
ADDRESS 1000 Nicollet Mall Minneapolis MN 55403 Building &
PHONE (012-- Y25V EMAIL MAR ,,
APPLICANT NAME AKC Services Inc FkE)Glalved
ADDRESS 18650 Collier Ave Suite B Lake Elsinore CA 92530
PHONE (951)471-8419 EMAIL info@akcservices.net
CONTRACTOR'S NAME Icon Identity Solutions I =,j c. OWNER BUILDER? ❑YES❑✓NO
BUSINESSNAME Icon Identity Solutions -7 mac .
ADDRESS 1418 Elmhurst Rd Elk Grove Village IL 60007
PHONE (847)364-2250 EMAIL
CONTRACTOR'S STATE LIC NUMBER 796721 LICENSE CLASSIFICATION C45
VALUATION $ $1,020.00 SQ FT 35.70 L SO FT
APPLICANT'S SIGNATURE C �- — DATE3
DEPARTMENT DISTRIBUTION CITY OF MEN IFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP X
INVOICE ^^^^� PAIDAMOUNT -'t
AMOUNT O/O'�•5 1- 6 CASH 0CHECK# O CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK It O CREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Deportment 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-5213