PMT16-02470 City of Menifee Permit No.: PMT16-02470
29714 HAUN RD. Type: Commercial Alteration
�ACCELA—> MENIFEE, CA 92586
MENIFEE Date Issued:
0 610 212 01 6
PERMIT
Site Address: 28125 BRADELY RD, Suite#170, Parcel Number: 337-302-022
MENIFEE, CA 92586 Construction Cost: $0.00
Existing Use: Proposed Use:
Description of HOURLY INSPECTION FOR C OF O(GHH MINISTRIES)
Work:
Owner Contractor
BRADLEY MEDICAL ASSOCIATES
445 SOUTH D ST
PERRIS, CA 92570
Applicant License Number:
MENIFEE, CA
Phone: 9516794667
Fee Description ,Oty Amount 151
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
$156.07
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 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 7000)of Division 3 of the Business and 0I am exempt from Ilcensure 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 1 acknowledge that,except for my personal residence
Expires Signature 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 Hit 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 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 this permit is issued. www.leeinfo.ca.eov/calaw.html.
Policy# Date
a 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 in 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: application and the information I have provided is correct.I agree to comply
Carrier
with all applicable city and county ordinances and state laws relating to
building constructtoyy.I a �Ou epresentatives of this city or county to
Policy# Expires enter id d fE red prope for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or Tess PR PERTY VS R OR�U&f RHE GENT
0I 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 become subject to the CITY BUSINESS LICENSE#
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 Date mixture containing a hazardous material equal to or greater that the
amounts specified an the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes 0 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 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(SC construction
or See cation from
checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Airlines
Qua
CONSTRUCTION LENDING AGENCY ciYes ONo
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) o Yes 0 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 Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to oyes 0 No
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT Date
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 IRRPI
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 apre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to he RRP-certified firms and comply with
than
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 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.aov/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 ❑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.
CERTIFICATE OF OCCUPANCY APPLICATION
Menifee
APN . _PMT Ike - 02410
DATE 1 PERMIT NUMBER
BUSINESS NAME GHH Ministries _ TYPE OF BUSINESS �1l�
ADDRESS u } S �,S iC IE �LJ. �'Ie-, ( lL iEArN k�'- CA 9���(c
NAME OF BUSINESS OWNER(S) �lr �C1r1C� L?,. Jr. ceL: tf(cm -rcV'1 Se-c �
ADDRESS(IF DIFFERENT FROM ABOVE) SQVh�
PHONE `�5i)�� - iIYL�i. EMAIL0{-IC"'e (' hhrnifllsfirleS •C���
OWNER OFB1 D U�IILDING'JC)khMGM1ef/ �fGCi14'j h4l' StI /�SS1 C4G�t
ADDRESS
�+- SC Vl 1 h (� Pe*_y 5" 0A_ `l jt11c:
PHONE _ Cr �Jf J1 - � 1
EMAIL _
DESCRIBE EXACT USE OF BUILDING: S�iC C- CTO j>
c°ti-� � �� e'�is�-►r�c� �cc :.���� e-I�'ink i r,
PREVIOUS USE OF BUILDING/SUITE GI�` 'C
APPLICANT ACKNOWLEDGEMENT
Applicant agrees that the Certificate of Occupancy shall be posted in a conspicuous location, and will operate subject
to the City's issuance of the Certificate of Occupancy.
1, �� YCw� hereby agree to comply with the above-described terms in this
Application for C to of Occupancy.
DATE
APPLIc
BUS LICENSE DATE ENGINEERING DATE
BUS LIC.NUMBER FIRE DATE
PLANNING DATE EMWD DATE
HEALTH DEPT DATE BUILDING DATE
REMARKS
City of Menifee Building& Safety Deportment 29714 Houn Rd. FAenifee, CA 92586 951-672-677 7
www.cityofinenifee.us Inspection Request Line
wenifee
DATE �r3� I�� PERMITNUMBER
ADDRESS 1 j �iMCI'E �C� S1�• �lV f��kl ��C Cp ��'S"$ID
BUSINESS NAME GHH Ministries
INTENDED BUSINESS USE �� - �
IS THIS A NEW BUSINESS IN THE CITY OF MENIFEE? YES CNO' (CIRCLE ONE)
ARE YOU THE FIRST TENANT TO OCCUPY THIS SPACE? YES �0 (CIRCLE ONE)
IS THE BUILDING EQUIPPED WITH FIRE SrPRNKLERS? YES tpLL (CIRCLE ONE)
SQUARE FOOTAGE I S 7. t.
NUMBER OF EMPLOYEES A - .3 4
NUMBER AND LOCATION OF RESTROOM FACILITIES
LIST ANY TOXIC CHEMICALS, FLAMMABLE/COMBUSTIBLE LIQUIDS OR GASES USED OR STORED WITH
MSDS SHEETS AND QUANTITIES OF EACH BELOW OR ON A SEPARATE ATTACHED SHEET(S):
• ARE YOU MAKING ANY IMPROVEMENT TO THE SUITE OR BUILDING OTHER THAN PAINTING,
PAPERING, FLOOR COVERING, MOVABLE CASES, SHELVING OR PARTITIONS NOT OVER 5' 9" HIGH?
YES NO (CIRCLE ONE)
• APPLICANT SHALL OBTAIN ALL REQUIRED CLEARANCES AND/OR APPROVALS FROM THE
APPROPRIATE WATER DISTRICT AND FIRE DEPARTMENT PRIOR TO ISSUANCE OF ANY
BUILDING PERMI
SIGNATURE DATE 1 I "o
PRINT NAME
TENAN OWNER / CONTRACTOR / ARCHITECT / ENGINEER (CIRCLE ONE)
CtTY STAFF USE ONLY
OCCUPANCY GRP TYPE OF CONST STAFF INITIALS
City of Menifee Building& Safety Department 2971-1 Houn Rd. Menifee, CA 92585951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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