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PMT16-01638 City of Menifee Permit No.: PMT16-01638 29714 HAUN RD. �J-1CCIELA? MENIFEE, CA 9258E Type: Commercial Alteration MENIFEE Date Issued: 09/26/2016 PERMIT Site Address: 30155 HAUN RD,Suite#102, MENIFEE, Parcel Number: 360-080-062 CA 92584 Construction Cost: $45,001.22 Existing Use: Proposed Use: Description of TENANT IMPROVEMENT"SPORT CLIPS'946 SF Work: Owner Contractor RICH DEVELOPMENT DOPPS CONSTRUCTION INC 1000 N WESTERN AVE,#200 142 BONITA AVENUE UNIT 104 SAN PEDRO, CA 90732 SAN DIMAS,CA 91773 Applicant Phone:9095927068 RICK DOPPS License Number: 846876 DOPPS CONSTRUCTION INC 142 BONITA AVENUE UNIT 104 SAN DIMAS, CA 91773 Fee Description O-t( Amount(S) Receptacle, Switch, Outlet&Fixture 53 376.00 Plumbing Fixtures and Vents, fixtures 8 141.00 Gas System 1 116.00 Water Heater 1 83.00 Sewer 1 160.00 Building Permit Issuance 1 27.00 Additional Plan Review Building 782 781.95 GREEN FEE 1 2.00 SMIP COMMERCIAL 1 13.00 New Construction Permit Fee 1 207.01 General Plan Maintenance Fee-Plumbing 1 24.50 General Plan Maintenance Fee-Electrical 1 18.80 General Plan Maintenance Fee-New 1 10.35 Construction $1,950.61 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 carded 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 with a licensed contractor(s)pursuant to the Contractors State License Law). I hereby affirm under penalty of perjury that I am under provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and ❑1 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 9 Licen a o. By my signature below I acknowledge that,except for my personal residence Expires�—.�� ((0 Signal re 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 DEC ON 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 www,leeinfo.ca.eov/calaw.html. this permit is issued. 9 p �f r Policy# W L � Cell q=P 44 ()j Date PROPERTY OWNER OR AUTHORIZED AGENT n I have and will maintain workers compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which o 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 policy owner or authorized to act on the property owners behalf.I have read this number are: , 0 application and the information I have provided is correct.1 agree to comply Carrier W.M[�( t( Cuo' _� 6)`f, , f Ill,�S l...t7 with all applicable city and county ordinances and state laws relating to �r building construction.I authorize representatives of this city or county to policy#Lk)L qO Wcl zib n, Expires '-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($SOD)or less PROPERTY OWNER OR AUTHORIZED AGENT o I certify that in the performance of the work for which this permit is issued, i+2Q�,j(!i I shall not emolov an ersons in a so as to become subject to the CITY BUSINESS LICENSE# o 1_1 I workers compensall n lav{ ofj ifornia,and ree that if I should become HAZARDOUS MATERIAL DECLARATION subject to thew r e s a e ation provisions o Section 3700 of the Labor Code,I shall in hwith m I e provisi Will the applicant or future building occupant handle hazardous material or n mixture containing a hazardous material equal to orgreater that the �licant D to -1 — fn — amounts�spe�_cified on the Hazardous Materials Information Guide? ARNING:FAILURE O ECURE WORKE OMPE ATION COVERAGE IS o Yes W. U WFUL,A ALL SUBJECT AN EMPLOYER CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building AND CIVIL FINES UP TOO HUNDRED THO ND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South ADDITION TO THE COST OF C ION,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 guidelf es CONSTRUCTION LENDING AGENCY ❑Yes ba 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 ,d>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 Ca"'orni alth&Safety C Section 25505 and 25534 concerning Contractors License Law for the reason(s)indicated below by the hazard a iai rep mg. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes No / Business and Professions Code).Any city or county that requires a permit to t teQ-9-6 -1 LD construct,alter,improve,demolish or repair any structure,prior to its PROPERTY AUTHO Z G 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 RENO I REPAIRAND AI License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA e��ovation,Repair and inting IRRP)Rule requires contractors Business and Professions Code)or that he or she is exempt from licensure receiving com�ensatien- 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-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 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.ei)a.gov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-g00-424-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. ❑No EPA Lead-Safe Certified Firm is required for this 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. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION Menifee DATE S PERMIT/PLAN CHECK NUMBER TYPE: 4XOMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION SY.ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES ) DESCRIPTION OF WORK Tz S' '�. v `I}l k, Fr-t4L •6 PROJECT ADDRESS S(!) NNLO L( 3 ASSESSOR'S PARCEL NUMBER 2 0.CQ0 - CkQ a LOT TRACT OWNER NAME PAW pawbOW& rA LL nAve ADDRESS \4��QCr CMCOti PHONE ,`t3Ql �i'sl- 1 ]�', EMAIL" APPLICANT NAME Tn e,4- I6aJ .(� e ADDRESS U<F it OL -SACK)I D,..�o- I PHONE �g� ,a` �� EMAIL C,L , 4C-L)N CJ-t CONTRACTOR'S NAME g 1LLL +o VL OWNER BUILDER? OYES NO BUSINESS NAME pp � ADDRESS / �, (gipK c, *1I() S I I PHONE elJ"7-SJ,��7U6�` EMAIL S- UR B 14 L L,-', CONTRACTOR'S STATE LIC NUMBER ' 7 LICENSE CLASSIFICATION VALUATION$ y. (jQ(7 \\ SO FT `Q L SO FT APPLICANT'S SIGNATURE U n DATE S Z DEPARTMENT DISTRIBUTION 2 CITV OF MENIFEEyUsLI�'E LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP ,/ (_wf INVOICE .O1 PAIDAMOUNTO, AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZEDLETTER O YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.citycfinenifee.us Inspection Request Line 951-246-6213