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PMT16-01497 City of Menifee Permit No.: PMT16-01497 29714 HAUN RD. T Commercial Alteration �!-�CCEL/R? MENIFEE,CA 92586 Type: MENIFEE Date Issued: 06/15/2017 PERMIT Site Address: 26850 SUN CITY BLVD,MENIFEE, CA Parcel Number: 337-230-004 92586 Construction Cost: $20,000.00 Existing Use: Proposed Use: Description of TENANT IMPROVEMENT"SUN CITY CIVIC ASSOC" Work: ADA COMPLIANT LAV,TOILETS, SHOWERS,AND URINAL REVISIONS APPROVED 1215/16 Owner Contractor SUN CITY CIVIC ASSOC NIMMO CONSTRUCTION 26850 SUN CITY BLVD 41957 BLACK MOUNTAIN TRAIL MENIFEE,CA 92586 MURRIETA,CA 92562 Applicant Phone:6198511206 MENIFEE,CA License Number:516415 Fee Description t Oft Amount 151 Receptacle,Switch,Outlet&Fixture 2 121.00 Receptacle, Switch, Outlet&Fixture 8 151.00 Plumbing Fixtures and Vents,fixtures 13 166.00 Building Permit Issuance 1 27.00 Additional Plan Review Building 384 384.15 Additional Plan Review Building 129 129.07 GREEN FEE 1 1.00 SMIP COMMERCIAL 1 6.00 New Construction Permit Fee 1 92.00 General Plan Maintenance Fee-Plumbing 1 8.80 General Plan Maintenance Fee-Electrical 1 6.05 General Plan Maintenance Fee-New 1 4.60 Construction $1,096.67 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 herebyaffrm under penalty of perjurythat I am under provisions of with alicensed contractor(s)pursuant to the Contractors State License Law). Chapter9(commencingwith 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 I acknowledge that,except for my personal residence Expires Signature in which I must have resided for at least one year prior to rompletion 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 th following website: by Section 3700 of the Labor Code,for the performance of work for which this permit is issued. zlem .ca. o fe .hPolicy# e❑I have and will maintain worker's compensation insurance,as required by POWNER OR AUT ORIZED AGEN section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I certify to each d f///�f��kkkif((eeee////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 Cartier with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy It Expires *nleprabove iden[ifi roperty forinspection purposes.(This section need not to be completed is the permit is for one-hundred dollars($100)or less OWNER 11AUTHORIZED /E T ❑I certify that in the performance of the work for which this permit is issued, I shall not emolov any persons in any manner so as to became subject to the CITY BUSINESS LICENSE# worker's 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 IS ❑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($300,000),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 WIII 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 ealth al Safety Code,Section 25505 and 25534 concerning rdou s material reporting. checkmark(s)I have placed next to the applicable Rem(s)(Section 7031.5 oyes ❑No ' Business and Professions Code).Any city or county that requires a permit to 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRP) 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[!censure 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 ply w78 an Applicant for a permit subjects the applicant to a civil penalty of not more residence ra childcare facility to be rental propertyfied firms and comply with than($S00). required practices.This includes rental property owners and property managers who do the paint-disturbing work themselves or through their ❑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( I all of or( )portion of the work,and the structure is www.epa.gov/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 Contractor's 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 bemuse: as owner of the property am exclusively contracting with licensed o Cactors to construct the project(Section 7044,Business and Professions ode:The Contractor's 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. C APPLICATION J "r.\ Jil;l� � Menifee SCANNED DATE PERMIT/PLAN CHECK NUMBER Pit-/Vnu - Goo HOC TYPE:IkCOMMERCIAL ❑RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME POOL/SPA []SIGN SUBTYPE: " &DDITION ,ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL of Men fee ❑NE//W ^7❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES Building & Safe y Dept. DESCRIPTION OF WORK ;iO L 43 A00 LTLOA) MAY 12 016 ,?,Cot Flpl��5 PROIECTADDRESS zkoa5b �7U� /►L�VP,� 9 ^7 Recel ed ASSESSOR'S PARCEL NUMBER c % —L ` Z 't� � �R�A IcT Z 7 PROPERTY OWNER'S NAMEc / U 1J Gl ��(� � ADDRESS Z&6 2-J�0 eluAi e PHONE e -M - Z- ( -43CO 7 EM^AIIL. , ,,t _. • U-/,)C GL�LC-c APPLICANT NAME �'^��- - C.L�1�l�EC'-V�" QAtj 0 ADDRESS Zpt 3 2i y V �J�\ Aft r- E �1� PHONE `�S'Z 'Z L (3� EMAIL DA,0 CONTRACTOR'S NAME OWNERBUILDER? ❑YES®NO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ 0), �O SO FT L SO FT APPLICANT'S SIGNATURE DATE C17-Y STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT OCASH OCHECKN OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT O CASH O CHECK A O CRED[TCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213