PMT16-02802 City of Menifee Permit No.: PMT1 6-02802
29714 HAUN RD. Type: Commercial Alteration
-C��CCIELA—> MENIFEE,CA 92586
MENIFEE Date Issued: 08/26/2016
P E R M I T
Site Address: 26840 CHERRY HILLS BLVD,MENIFEE, Parcel Number:
CA 92586 Construction Cost: $0.00
Existing Use: Offire Proposed Use:
Description of HOURLY INSPECTION FOR CERTIFICATE OF OCCUPANCY FOR"JAMES R MASUHR, DDS"
Work:
Owner Contractor
CHERRY HILLS PLAZA,LLC JAMES R MASUHR, DDS
26834 CHERRY HILLS BLVD JAMES R MASUHR, DDS
MENIFEE, CA 92586 26840 CHERRY HILLS BLVD
Applicant Phone: 9516727889
JAMES R MASUHR, DDS License Number: 16-PEOP-00031
JAMES R MASUHR, DDS
26840 CHERRY HILLS BLVD
MENIFEE,CA 92586
Phone:9516727889
Fee Description Qtv Amount($
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 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_Pemit Template.rpt Page I of 1
CITY OF MENIFEE
property who builds or improves thereon,and who contracts for the projects
LICENSED DECLARA110N with a licensed contTaCtOf(S)pursuant to the contractors State License Law).
I hereby affirm under penalty of perjury that I am under Provisions of a I am exempt from ficensure under the contm&6?s State License Law for
Chapter9(commencing with section 7000)of Division 3 of the Business and
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
in which I must have resided for at least one year prior to completion of
Expires_Signature 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
a 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 workees 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 wwvi.IeRinfo.ca.gciv/caIaw.htmI
this permit is issued. Date
policy# PROPERTY OWNER OR AUTHORIZED AGENT
o I have and will maintain worker's compensation insurance,as required by ci By my signature below I certify to each of the following:I am the property
section 3700 of the Labor Code,for the performance of the work for which rtV owner's behalf.I have read this
this permit is issued.my worker's compensation insurance carrier and policy owner or authorized to act on the prope
application and the information I have provided Is correct.I agree to comply
number are: with all applicable city and county ordinances and state laws relating to
Carrier building construction.I a uthorize representatives of this city or county to
Policy# Expires enter the above identified roperty for Inspection purposes.
mired Date
(This section need not to be completed is the permit is for one-hu 1�g
dollars($100)or less OPEkTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued'
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,a nd agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's com pensation provisions of Section 3700 of the La bor Will the appfica nt or future building occupa nt handle hazardous material or a
Code,I shall forthwith comply with those provisions. mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING: AILURE TO SECURE WORKEWS COMPENSATION COVERAGE IS ciYes ciNo
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 SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY ciYes uNo
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) 0 Yes 0 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 perj ury that I am"em pit from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes ct 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 WNER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement EP ATION REPAIR AND PAINITINGOIRPI
that he or she is licensed pursuant to the provisions of the Contractor's State _A�RENOVIIM I I
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 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
ci 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( I portion of the work,and the structure is www.ep Roy/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-8(lo-424-LEAD(5323).
Code,The Contractor's State License Law does not apply to an owner of a a An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the Certified Firm Name:
property provided that the improvements are not intended or offered for
sale.if,however,the building or improvern ntissold within oneyearof Firm Certification No.:
completion,the Owner-Builder will have th:burden of proving that itwas n No EPA Lead-Safe Certified Firm is required for this project because:
not built or improved for the purpose of sale.
0 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contnctoes 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.
aw pf mpHifee
Oijilding & Safety Dept.
AUG 2 6 2016
Received DATE
BUSINESS NAME J R M U PV�; I
13USINESS ADDRESS Z_ (, ;144) a OL-P2
NAME(S) OF BUSINESS OWNERS k), MA:51zaR
PHONE NUMBER C�S I (OZ7 EMAIL ell/A) ?e 12/57 14
OWNER OF BUILDING 1A,4t r 4, lts Fle�ze�
OWNER OF BUILDING ADDRESS ZWq CkeM 1"15 131-'Jd Me-K 14ef 'Zf
INTENDED BUSINESS USE �) f-V\.�rc \ -
IS THIS A NEW BUSINESS IN THE CITY OF MENIFEE? YES NO (CIRCLE ONE)
YES NO (CIRCLE ONE)
ARE YOU THE FIRST TENANT TO OCCUPY THIS SPACE? 8
IS THE BUILDING EQUIPPED WITH FIRE SPRNKLERS? NO (CIRCLE ONE)
SQUARE FOOTAGE NUMBER OF EMPLOYEES
NUMBER AND LOCATION OF RESTROOM FACILITIES@ BXIUE12r��ICE�-
• LIST ANY TOXIC CHEMICALS, FLAMMABLE/COMBUSTIBLE LIQUIDS OR 6A�>U) USED OR
STORED WITH MSDS SHEETS AND QUANTITIES OF EACH BELOW OR ON A SEPARATE
ATTACHED SHEET(S):
• ARE YOU MAKING ANY IMPROVEMENTS TO THE SUITE OR BUILDING OTHER THAN PAINTING,
PAPERING, FLOOR COVERING, MOVABLE CASES,SHELVING OR PARTITIONS NOT OVER S'9"
HIGH? YES Q (CIRCLEONE)
Applicant agrees that the Certificate of Occupancy shall be posted in a conspicuous location, and will
operate subject to the City' issuance of the Certificate of occupancy.
1, �; A , hereby agree to comply with the above-
described terms in this Application of Certificate of occupancy.
SIGNATURE DATE
J 0 q.4
A p PERMITINUMBER
PN
INVOICE AMOUNT OCCUPANCYCROUP
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