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PMT17-00294 City of Menifee Permit No.: PMT17-00294 29714 HAUN RD. Type: Sign -Permanent �/-�CCEL/? MENIFEE,CA 92586 MENIFEE Date Issued: 01/31/2017 PERMIT Site Address: 29737 ANTELOPE RD, MENIFEE, CA Parcel Number: 340-020-064 92584 Construction Cost: $19,500.00 Existing Use: Proposed Use: Description of INSTALL 4 SETS ILLUMINATED CHANNEL LETTER SIGNS"LA FITNESS", 2 MONUMENT SIGN Work: INSERTS, 1 NON-ILLUMINATED WALL-MOUNTED ART MURAL Owner Contractor FITNESS INTERNATIONAL ARCHITECTURAL DESIGN&SIGNS INC 3161 EAST MICHELSON DRIVE,#600 1160 RAILROAD STREET IRVINE, CA 92612 CORONA,CA 92882 Applicant Phone:9512780680 DIED AZURIN License Number.714309 ARCHITECTURAL DESIGN&SIGNS INC 1160 RAILROAD STREET CORONA, CA 92882 Fee Description Oft Amount ISI Sign Permit 7 286.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Building 1 14.30 $328.30 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_Pennit_Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe 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 o I am exempt from licensure under the Contractors State License Law for Professions Code and my license is in full force and effect. G� the following reason: License Class C 4s License No./�1 �� I By my signature below I acknowledge that,except for my personal residence Expires l(9_//7 Signature L%VNGe-r'(��fJ KA�_. in which l must have resided for at least one year prior to completion of 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 o 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 workers 7D44 of the Business and Professions Cade,is available upon request when compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following websfte: by Section 3700 of the Labor Code,for the performance of work for which this permit is issued. `� 7 www.leeinfo.ca.eov/calaw.html. Policy# (rY �y �! Date rg�I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,forthe performance of the work for which o By my signature below I certify to each of the following:l am the property this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this number are: j� application and the information I have provided is correct.I agree to comply Carrier UCL�e t/>, �(>P'�-C_ ZUG• `4/r with all applicable city and county ordinances and state laws relating to building construction.l authorize representatives of this city or county to Policy# 2_(2 Expires ©� �S�/ 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 I certify that in the performance of the work for which this permit is issued, I all not employ any persons in any mannerso as to become subjectto the CITY BUSINESS LICENSE# workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 3700 of the Labor Code,1 shalll�lJforthw� ithcomply with those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant(.wG an P/J it /- ---- Date J 0l l7 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 Dyes ONO UNLAWFUL,AND SHALL SUBJECTAN 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 forthe construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)7 See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY oYes ❑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 forthe performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) ❑Yes ❑No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting. Business and Professions Code).Any city or county that requires a permit to oyes D No Date construct,alter,improve,demolish or repair any structure,prior to its issuance,also requires the applicant forthe permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRPI 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 forthe 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 ownerof 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.eua.eov/lead 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 Contractors State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible forthis 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 forthe purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project because: o I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7D44,Business and Professions Code:The Contractors 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 BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION '.. 'Menifee DATE 01/31/2017 PERMIT/PLAN CHECK NUMBER TYPE: ❑✓ COMMERCIAL []RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA [Z]SIGN SUBTYPE: []ADDITION [—]ALTERATION [—]DEMOLITION [—]ELECTRICAL ❑ MECHANICAL ❑NEW []PLUMBING ❑RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK four(4)sets of internally illuminated channel letters(see design for square footage). One(1)art mural, non-illuminated + PROJECT ADDRESS 29737 Antelope Road,Menifee, CA 92584 It Df Menifee ASSESSOR'S PARCEL NUMBER ��y.� BUllding 8, a y ep . �}�' �'(xpy LOT TRACT PROPERTY OWNER'S NAME JA - 3 ADDRESS AkUl i jpFl PHONE EMAIL APPLICANT NAME Architectural Design&Signs, Inc ADDRESS 1160 Railroad Street,Corona,CA PHONE (951)278-0680 EMAIL bcohen@ad-s.com(714)906.2029 CONTRACTOR'S NAME Architectural Design&Signs, Inc OWNER BUILDER? ❑YES❑NO BUSINESS NAME ADDRESS same as above PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER 714309 LICENSE CLASSIFICATION c45 VALUATION$ $ 19,500.00 FT see plans L SQ FT APPLICANT'S SIGNATURE DATE 01/31/2017 CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS UCENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I GREEN I SMIP �C INVOICE PAID AMOUNT AMOUNT OCASH 0CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCSRO VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213