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PMT16-01238 City of Menifee Permit No.: PMT16-01238 29714 HAUN RD. Type: Commercial Alteration <A-CCEL/-' MENIFEE, CA 92586 MENIFEE Date Issued: 0 6/0 312 01 6 PERMIT Site Address: 27701 SCOTT RD, Suite#304, MENIFEE, Parcel Number: 384-180-038 CA 92584 Construction Cost: $0.00 Existing Use: Office Proposed Use: Description of TENANT IMPROVEMENT FOR"HEADLINERS BARBERSHOP"ADD 12 NEW 20AMP CIRCUITS Work: REQUIRES SEPARATE SUBMITTAUPERMIT FOR SIGN Owner Contractor MENIFEE PARTNERS HEADLINERS BARBERSHOP 4909 MURPHY CANYON RD#405 27701 SCOTT RD SUITE 304 SAN DIEGO, CA 92123 MENIFEE, CA 92584 Applicant Phone:9516397523 GERARDO VILLA License Number: 16-PEOP-00016 HEADLINERS BARBERSHOP 27701 SCOTT RD SUITE 304 MENIFEE, CA 92584 Phone:9516397523 Fee Description city Amount ISI Receptacle, Switch, Outlet&Fixture 28 251.00 Building Permit Issuance 1 27.00 Inspections not specified 129 129.07 Additional Plan Review Building 19 19.30 GREEN FEE 1 0.00 General Plan Maintenance Fee-Building 1 6.45 General Plan Maintenance Fee-Electrical 1 12.55 $445.37 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 budding 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_Blog_Perrnit_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 D 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 License No. By my signature below I acknowledge that,except for my personal residence Expires Signature in'which I must have resided for at least one year priorto completion of Improvements covered bythis permit.I cannot legallysell 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 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 this permit is issued. www.leeinfa.m.eov/calaw.html. Policy g 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 ach of the following:I am the property this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on t property owners behalf.I have read this numberare: application and the i a I have provided is correct.I agree to comply Carrier with all applicab city county ordinances and state laws relating to building con uctia authoriz s atives of this city or county to Policy fJ Expires enterth ove' p ertyf Jospection purposes /./�1 (This section need not to be completed is the permit is for one-hundred l'/°s� Date LO dollars($100)or less PROPE OW IEVOR ALIT RIZED AGENT D I certify that in the performance of the work forwhich this permit is issued, I shall not emolov any persons in any manner so as to become subject to the B NESS LICENSE workers compensation laws of California,and agree that if I should become RDOUS 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 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 o Yes '1(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 SECOON 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines CONSTRUCTION LENDING AGENCY D Yes ,�No 1 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) D Yes 00 OWNER BUILDER DECLARATIONS I have read Hazar s Material Information Guide and the SCAQMD perm.iti checklis understand my require ents under the State of I hereby affirm under penalty of perjury that I am exempt from the Califo is Healt Safety Cod a on 2 5 and 25534 concerning Contractors License Law for the reason(s)Indicated below by the ha rdous m po i checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 es / Business and Professions Code).Any city or county that requires a permit to Date I �� construct,alter,improve,demolish or repair any structure,prior to Its PROP TY NER4RAU 0 ZED 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 REN VATION AIR AND PAINTING RRP License Law(Chapter 9(commencing with Section 7000)of Division 3 of the ;receiving e EPA Renovati n,Repair and Painting(RRP)Rule requires contractors Business and Professions Code)or that he or she is exempt from licensure 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 ar 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 D 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 o 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. o No EPA Lead-Safe Certified Firm is required for this project bemuse: ❑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.