PMT16-03364 I
City of Menifee Permit No.: PMT1 6-03364
29714 HAUN RD.
<A_CCIEI_A> MENIFEE, CA 92586 Type: Commercial Alteration
MENIFEE Date Issued: 10/12/2016
P E R M I T
Site Address: 30340 HAUN RD, MENIFEE, CA 92584 Parcel Number: 360-690-021
Construction Cost: $0.00
Existing Use: Proposed Use:
Description of HOURLY INSPECTION FOR CERTIFICATE OF OCCUPANCY FOR"CVS PHARMACY-TARGET"
Work:
Owner Contractor
TARGET CORPORATION CVSIPHARMACY
1000 NICOLLET MALL 30340 HAUN RD
MINNEAPOLIS, MIN 55403 MENIFEE, CA 92584
Applicant Phone:4017651500
GARY WEAVER License Number: 16-PEOP-00032
CVS/PHARMACY
30340 HAUN RD
MENIFEE,CA 92584
Phone:4017651500
Fee Description Amount
Building Permit Issuance 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 violatilon 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 shail be
forfeited.
AA�B1dg_Perrnjt_Temp1ate.qPt 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 a I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full form 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 completion of
improvements covered by this permit.I cannot legally sell a structu re 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 pena Ity of perju ry 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 a nd Professions Code,is available upon req uest 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.IegInfo.ca.irov/calaw.html.
Policy# Date
a I have and Will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which a By my signature below I certify to each of the 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
with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
Policy# Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-h undred ,I /' Date
dollars($100)or less PROVRTY OWNER OR AUTHORIZED AGENT
a 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,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workees 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
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Infor-rnation Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ayes oNo
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 HUN DRED THOUSAND DOLLARS($100,000),IN occupant require a perm it 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 ayes 0 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 lairthe performance of the work which this permit is Issued outer boundary of a school?
(Section 3097 Civil Code) a Yes a 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 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 ayes a 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 The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he orshe 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-certffied 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
then($soo). managers who do the paint-ifisturbing work themselves or through their
a 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( )portion of the work,and the structure is www.epa.guyllead 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 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. a No EPA Lead-Safe Certified Firm is required for this pplect 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 Contractor's State License Law dam not apply to an owner of a If you r project does not comply with EPA RAP rule please fill out the RAP
Acknowledgement
CERTIFICATE OF OCCUPANCY APPLICATION
M le nife e
mill
DATE 8/412016 PERMIT NUMBER
BUSINESS NAME CVS/pharmacy#17522 TYPE OF BUSINESS PharTacy
ADDRESS- 30340 Haun Rd Marilee,CA 92584
NAME OF BUSINESS OWNER(S) Garfield Beach CVS,L.L.C.
ADDRESS(IF DIFFERENT FROM ABOVE) One CVS Drive-MC 1160 Woonsocket,Rl 02895
PHONE (401)765-1500 EMAIL DiannL.-_ 3nd@CVShealth.com
OWNER OF BUILDING Target Corporation
ADDRESS 1000 Nicollet Mall Minneapolis,MN 55403
PHONE (612)304-6073 EMAIL
DESCRIBE EXACT USE OF BUILDING: Pharmacy only
PREVIOUS USE OF BUILDING/SUITE Pharmacy
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.
I, Linda M. Cirribron, Assist. Secretary hereby agree to comply with the above-described terms in this
Application for Certificate of Occupancy.
DATE
APPLICANT
CITY STAFF USE ONLY (PLEASE SIGN AND DATE IFAPPROVED)
BUS LICENSE DATE ENGINEERING DATE
BUS LIC.NUMBER FIRE DATE
PLANNING DATE EMWID -DATE
HEALTH DEPT DATE BUILDING DATE
REMARKS
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityefimenifee.us Inspection Request Line
Ak 01
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CERTIFICATE OF OCCUPANCY TENANT DISCLOSURE FORM
.�Z'. X�'-`Menifee
DATE 08/04116 PERMIT NUMBER ('r�
ADDRESS 30340 Haun Rd Menifee,CA 92584
BUSINESSNAME CVS/phamacy#17522
INTENDED BUSINESS USE Phamacy
IS THIS A NEW BUSINESS IN THE CITY OF MENIFEE? DS NO (CIRCLE ONE)
ARE YOU THE FIRST TENANT TO OCCUPYTHIS SPACE? YES (& (CIRCLE ONE)
IS THE BUILDING EQUIPPED WITH FIRE SPRNKLERS? NO (CIRCLE ONE)
SQUARE FOOTAGE 877
NUMBER OF EMPLOYEES 10
NUMBER AND LOCATION OF RESTROOM FACILITIES
LISTANYTOXIC CHEMICALS, FLAMMABLE/COMBUSTIBLE LIQUIDS OR GASES USED OR STORED WITH
MSDS SHEETS AND QUANTITIES OF EACH BELOW OR ON A SEPARATE ATTACHED SHEET(S):
n/a
ARE YOU MAKING ANY IMPROVEMENT TO THE SUITE OR BUILDING OTHER THAN PAINTING,
PAPERING, FLOOR COVERING, MOVABLE CASES,SHELVING OR PARTITIONPLO'T OVER 5' 9- HIGH?
ts) 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 PERMITS
SIGNATURE DATE 8/4/2016
PRINTNAME Linda M.Cimbron,Assistant Sauetary
e/ OWNER / CONTRACTOR / ARCHITECT / ENGINEER (CIRCLE ONE)
CITY STAFF USE ONLY
OCCUPANCY GRP I I TYPE OF CONST STAFF INITIALS
City of Menifee Building&Safety Department 29714 Haun Rd Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213