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PMT16-03435 City of Menifee Permit No.: PMT16-03435 29714 HAUN RD. <A-CCELJ - MENIFEE,CA 92586 Type: Commercial Alteration MENIFEE Date Issued: 10119/2016 P E R M I T Site Address: 27271 ETHANAC RD, Suite#102, Parcel Number: 331-110-030 MENIFEE,CA 92585 Construction Cost: $0.00 Existing Use: Proposed Use: Service Station Description of HOURLY INSPECTION FOR CERTIFICATE OF OCCUPANCY FOR"TOP TECH SMOG" Work: Owner Contractor JIM NESS TOP TECH SMOG 28455 OLD TOWN FRONT ST#207 27271 ETHANAC RD#102 TEMECULA, CA 92589 MENIFEE,CA 92585 Applicant Phone:9517752592 MICHAEL HARTFIELD License Number: 16-PEOP-00033 TOP TECH SMOG 27271 ETHANAC RD#102 MENI FEE,CA 92585 Phone:9517752592 Fee Description QtV Amount($1 Building Permit Issuance 1 27.00 Inspections not specified 129 129.07 $166.07 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__B1dg_Permit-Temp1ate.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 0 1 a in exempt from licensure 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 I acknowledge that except for my personal residence Expires Signature in which I m ust have resided for at least one year prior to completion of WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I have built as an owner-builder if it has not been constructed in Its entirety by o I hereby affirm under pen@ Ity of perjury one of the following decla rations:I licensed contractors.I understand that a copy of the applicable law,Section have and will maintain a certifinte 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 La bor Code,for the performance of work for which this permit is issued. wwvv.legmfio.ca.aoy/czilaw.htmI. Policy# Date ci 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 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 lowner or authorized to act an the property ownees behalf.I have read this number are; application and the information I have provided is correct.I agree to comply Carrier with all applk:able city and county ordinances and state laws relating to ulidingco struction.I authorize representatives of this city orcountVto Policy# Expires an! th a ove Identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred dollars($100)or less Date ci I certify that In the performance of the work for which this permit Is Issued, PRP%RTY OWNER OR AUTHORIZED AGENT I shall not emolov 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 D�ECLARATION subject to the worker's 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 on the Hazardous Materials Information Guide? WARNING,FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ci Yes a No UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applim nt or future building AND CIVIL FINES UP TO ONE H UNDRED THOUSAND DOLLARS($200,000),1 N ADDITION TO THE COST OF COMPENSATION, occupant require a permit for the construction or modification from South DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQM D)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY aYes 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) a Yes a No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQM D I hereby affirm under pena RV of perjury that I a m exempt from the permitting checklist.I understand my requirements under the State of Contractor's License Law for the reason(s)indioted below by the California Health&Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the a pplicable item(s)(Section 7031.5 hazardous material reporting. Business and Professions Code).Any city or county that requires a permitto oYes ci No construct,alter,improve,demolish or repair any structure,prior to its Date Issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT 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 700D)of Diviision 3 of the Business and Professions Code)or that he or she is exempt from licensure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint in a pre-1978 an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to be RRP-certified firms and comply with than($500). required practices.This includes rental property owners and property managers who do the paint-disturbing work themselves or through their a 1,as owner of the property,or my employee with wages as their sole employees.For mom information about EPA's Renovation Program visit! compensation,will do( I all of or I I portion of the work,and the structure is www.epagovIlead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800424-LEAD(5323). Code,The Contractors State License Law does not apply to an owner of a property who,through employees!or personal effort,builds or improves the o An EPA Lead-Safe Certified Renovator will be responsible for this project 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 completion,the Owner-Builder will have the burden of proving that it was Firm Certification No.: not built or improved for the purpose of sale. u No EPA Lead-SafL Certified Firm is required for this project because: ci 1,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 71344,Business and Professions Code:The Contractor's 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. T1, fj- u T?5.13,jk� Plans acceptablii for permit Issuance OCT 19 2016 gily of Me n'L P I A n cut DATE PERMITNUMBER 'DA 7r ADDRESS 2, �4haA(A r, 9 A-- AA BUSINESS NAME -I;p -FeC,h INTENDED BUSINESS USE Sryq)� jA-j n r� _ JO(L 15 THIS ANEW BUSINESS IN THE CITY OF MENIFEE? NO (CIRCLE ONE) ARE YOU THE FIRST TENANT TO OCCUPY THIS SPACE? YES NCO (CIRCLE ONE) IS THE BUILDING EQUIPPED WITH FIRE SPRNKLERS? (!E7)S NO (CIRCLE ONE) SQUARE FOOTAGE 2 1 wo NUMBER OF EMPLOYEES I 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�7' 9- HIGH? YES (CIRCLE ONE) APPLICANT SHALL OBTAIN ALL REQUIRED CLEARANCES AND/011 APPROVALS FROM THE APPROPRIATE WATER DISTRICT AND FIRE DEPARTMENT PRIOR TO ISSUANCE OF ANY BUILDING PERMITS SIGNATURE DATE LC) - j. PRINTNAME TENANT/ OWNER / CONTRACTOR ARCHITECT ENGINEER (CIRCLE ONE) STAFF INITIALS OCCUPANCYGRP TYPE OF CONST ID City of Menifee Building&Sofet,v Deportatem 29714 Houn Rd. Menifee, CA 92586 951-672-6777 wtvI-v.cityofrnenifee.US Inspection Request Line 951-246-6213 APN - 3-s I 'lioo—.30 CERTIFICATE OF OCCUPANCY APPLICATION - Wenifee DATE io- 1-7- 1 PERMITNUMBERPM%(0e9 ;5*60' BUSINESSNAME TOP 18d\ SM2_� TYPEOFBUSINESS sa)QQ 1,0Wyi0f) ADDRESS 1-2 1-711 alkarkAt. 'RQ �d q2 CT D-1 M 0 A I f:fL NAME OF BUSINESS OWNER(S) MiA0.0-1 LkMiIiPjd ADDRESS(IF DiFFERENTFROM ABOVE) .2_'2_5S0 RC(AC_K RA �ytvo Ira L(2c; 6 PHONE qS I -_77 C; S 112 EMAIL OWNEROFBUILDING =JI&:Jbt� T\rY\ UOSS ADDRESS 2-Je S�fl. i�� t r)(A-)rx C—f 0 fl� Sf ,ud-�O? Lowy u)In Cq_�2599 PHONE q 5) - S5� 1 - 12- 111 6� EMAIL DESCRIBE EXACT USE OF BUILDING: sm% r'KaL-K IoCCJJ� Qa PREVIOUS USE OF BUILDING/SLITTE RW07kt- f-;r\Qf� U10 M 0k U 0- APPLJCANT ACKNOWLEDGEMENT Applicant agrees that the Certificate of Occupancy shall be posted In a conspicuous location,and will operate subject to t e I s issuance of�t�helfl te of Occupancy. hereby agree to comply with the above-described terms in this ApblVic9lon for certificadof b66upancy. �LirgtPAA J-i�h Nea DATE lo -I) - I f- AF1?UCANT _7V BUS LICENSE DATE ENGINEERING DATE BUS LIC.NUMBER FIRE DATE <,ee A+WAwA DATE EMWD —DATE PLANNING HEALTH DEPT DATE BUILDING— DATE REMARKS City of Meli ifee 6 t iildfng&Scifety Dep o!ti 7 ien t 2 9 7 Ho un Rd. Me n ifee, CA 02586 951-6 72-6 777 www.citycfmenifee.us inspection Request Line