PMT16-03478 City of Menifee Permit No. PMT16-03478
29714 HAUN RD. Type: Sign -Permanent
41��CCIELA> MENIFEE,CA 92586
MENIFEE Date Issued: 1012112016
P E R M I T
Site Address: 28125 BRADLEY RD, Suite#245, Parcel Number: 337-302-022
MENIFEE,CA 92586 Construction Cost: $2,500.00
Existing Use: Proposed Use:
Description of INSTALL TWO 55.25 NON ILLUMINATED WALL SIGNS
Work:
Owner Contractor
BRADLEY MEDICAL ASSOCIATION-JOHN MOTrE CAREY SIGN CORPORATION
28125 BRADLEY RD 2871 BLUE STAR STREET
MENIFEE,CA 92570 ANAHEIM,CA 92806
Applicant Phone:7146308414
License Number:376085
Fee Description pim Amount
Sign Permit 2 190.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 9.50
$227.50
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specific;ations 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.BldgPermit—Template.rpt Page 1 of I
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am 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. _S_X 08'5' By my signature below I acknowledge that,except for my personal residence
Expires Signature inwhichl must have resided for at least one year prior to completion of
:;��z 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
ci 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 71344 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 www.leginfo-ca.gov/calaw.htm].
this permit is issued.
Policy# PROPERTY OWNER OR AUTHORIZED AGENT Date
II have and will maintain worker's compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which o 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
,�S� 4� with all applicable city and county ordinancesand state laws relatingto
Carrier building construction.I authorize representatives of this city or county to
Policy# Expires--Y/ -7 enter the above identified property for inspection purposes.
(This section need not to be completed Is the permit is for one-hundred Date
dollars($100)or less PROPERTY 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 subjecitto the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workerFs compensation provisions of Section 3700 of the Labor
Code,I shall forth 'th I 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?
LALA_RNING.FAILURE IrSECURE WORKER!S COMPENSATION COVERAGE IS 0 Yes /No
UNLAWFUL,AND SHALLSUBJECTAN 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 CoastAlr Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidellnes
CONSTRUCTION LENDING AGENCY 0 Yes �(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 for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) o Yes /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 2550S and 2S534 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
Business and Professions Code).Any city or county that requires a permit to Ffes o No Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNEFAUR 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 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
o 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.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LFAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a ci An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,th rough em playeee 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 yea r of Firm Certification No.:
completion,the Owner-Bu ilder will have the bu rden of proving that it was
not bu Ht or improved for the pu rpose of sale. ci No EPA Lead-Safe Certified Firm is required for this project because:
o 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 does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
& SAFETY PERMIT/PLAN CHECK APPLICATION
"'Menifee
DATE PERMIT/PLAN CHECK NUMBER b3'4070
TYPE: OCOMMERCIAL ORESIDENTIAL OMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOUTION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER SQUARES—
DESCRIPTION OF WORK (1-4 s��, A dt:,� -r
'Al-11,0-4..z.)
PROJECTADDRESS
ASSESSOWS PARCEL NUMBER '!)31 '60L* 0 LOT 1(f TRACT
OWNER NAME
ADDRESS Z-k-/ 'ZS- g 60, Aa/ 5u-- S t C A, 9 ZS-7'0
PHONE EMAIL
APPLICANT NAME rer-c-y j;e-
ADDRESS Zrc-71 <4, !4 C,4 q ZAL�
PHONE EMAIL LS-P,.Co Ce-� 5,,p, -C-
CONTRACTOR'S NAME
C. OWNER BUILDER? 0 YES ONO
BUSINESSNAME
ADDRESS e-.r,-7/ gf!jz
PHONE (�eey) r,�22 —.rqlq EMAIL �S-
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SO FT L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE �� GREEN �MIP I I
INVOICE Is 2tq. PAIDAMOUNT OCASH OCHECK# 0 CREDIT CARD VISAIMC
AMOUNT
PLAN CHECK FEES PAIDAMOUNT 0 CASH Q CHECK# CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 No DLNUMBER NOTARIZED LE17ER 0 YES 0 NO
City of Menifee Building& Safety Department 29714 Haun Rd Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213