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PMT16-01153 City of Menifee Permit No.: PMT16-01153 29714 HAUN RD. Type: Commercial Alteration < -ICCEL/-> MENIFEE,CA 92586 MENIFEE Date Issued: 08/30/2016 PERMIT Site Address: 28500 BRADLEY RD, MENIFEE, CA Parcel Number: 336-030-006 92586 Construction Cost: $36,000.00 Existing Use: Proposed Use: Description of ADA UPGRADES TO 6 STUDIO UNITS Work: Owner Contractor SUN CITY RETIREMENT HOUSING FOUNDATION, INC MILES CONSTRUCTION GROUP INC 911 N STUDEBAKER RD 27226 VIA INDUSTRIA LONG BEACH, CA 90815 TEMECULA, CA 92590 Applicant Phone:9512602504 VESELY ARCHITECT License Number: 976339 CA Fee Description Qtv Amount IS1 Receptacle, Switch, Outlet&Fixture 20 211.00 Plumbing Fixtures and Vents,fixtures 9 146.00 Sewer 1 150.00 Building Permit Issuance 1 27.00 Additional Plan Review Building 513 512.59 GREEN FEE 1 2.00 SMIP COMMERCIAL 1 11.00 General Plan Maintenance Fee-Plumbing 1 14.80 General Plan Maintenance Fee-Electrical 1 10.55 $1,084.94 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 staled,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). Chapter9(commencing with section 700D)of Division 3 of the Business and 01 am exempt from licensure under the Contractors State License Law for Professions Code and my license is in full force and effect. �f 19 the following reason: Lice ns Class S License No. / � I By my signature below I acknowledge that,except for my personal residence Expire Signature - in which I must have resided for at least one year prior to completion of WORKER'S COMPENSATION DECLARATION improvements covered bythis 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 ❑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 by Section 3700 of the Labor Code,for the performance of work for which this application is submitted or at the following website: this permit is issued, www.leeinfo.ca.eov/calaw.html. Policy# Date �,,-.•fhave and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT 1 section 3700 of the La bar 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 polity owner or authorized to act on the property owners behalf.I have read this number are: )/ application and the information I have provided is correct.I agree to comply Carrier I(� with all applicable city and county ordinances and state laws relating to �1 q building construction.I authorize representatives of this city or county to Policy# ��(01 I I�. O Expires �� enter the above identified property for inspection purposes. (This section need not to be completed is the permi is for one-hundred dollars($100)or less Date 0[certify that in the performance of the work for which this permit is issued, PROPERTY OWNER OR AUTHORIZED AGENT 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 subject to the workers compensation provisions of Section 3700 of the Labor HAZARDOUS MATERIAL DECLARATION Code,I shall forth 'th c ply 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 IS D Yes �S No UNLAWFUL,AND SHALL SURIECP AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN Will the intended use of the building by the applicant or future building ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)7 See permitting checklist for guidelines CONSTRUCTION LENDING AGENCY ❑Yes/"a 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 IF'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 Cade,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applimble item(s)(Section 7031.5 efi hazardous me ;/lI reportln� Business and Professions Code).Any city or county that requires a permit to Ryes 0 No construct,alter,improve,demolish or repair any structure,priorto its I^� Date Zy D Issuance,also requires the applicant forthe permit to file a signed statement PROPERTY CWNfR OR AUTH111RIZEDAGENT that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRPI License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt from licensure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint In a pre-1978 an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to be RRP-certified firms and comply with than($500). required practices.This includes rental property owners and property managers who do the paint-disturbing work themselves or through their D 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.eovhead or contact the National Lead Information Center at not Intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5373). Code,The Contractors State License Law does not apply to an owner of a property who,through employees'or personal effort,builds or improves the 0 An EPA Lead-Safe Certified Renovatorwill be responsible forthis project 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 completion,the Owner-Builder will have the burden of proving that it was Firm Certification No.: not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required forthis project because: a 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.