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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 -Ppj : - Uqo-oa I 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