PMT17-00979 City of Menifee Permit No.: PMT17-00979
29714 HAUN RD. Type: Commercial Alteration
<A_CCEL/_> MENIFEE,CA 92586
MENIFEE Date Issued: 0 410 312 01 7
PERMIT
Site Address: 268878 CHERRY HILLS BLVD, MENIFEE, Parcel Number: 337-320-016
CA 92586 Construction Cost: $0.00
Existing Use: Proposed Use:
Description of HOURLY INSPECTION FOR CERTIFICATE OF OCCUPANCY FOR"MARTHA'S CLOTHES&
Work: PERMANENT MAKE-UP
Owner Contractor
CHERRY HILLS PLAZASTEVE TAPLEY MARTHA'S CLOTHES&PERMANENT MAKE-UP
P. O. BOX 643 26878 CHERRY HILLS BLVD
MENIFEE,CA 92586 MENIFEE,CA 92586
Applicant Phone: 5623966985
MARTHA QUINTERO License Number: 17-PEOP-00011
26878 CHERRY HILLS BLVD
MENIFEE,CA 92586
Phone:5623966985
Fee Description Cltv Amount ISI
Building Permit Issuance 1 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 carded 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_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
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 D I am exempt from licensure underthe 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 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
❑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 7044 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 website:
by Section 3700 of the Labor Code,for the performance of work for which www.leainfo.ca.gov/caIaw.htrnI.permit is issued.
Policy It Date
❑I have and will maintain workers 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 workers compensation insurance carrier and policy owner or authorized to act on the property owners 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 p Expires enter the above identifie propererrte for inspection purposes.
(This section need not to be completed is the permit is for one-hundred `� {�j� Date 4- —7—zo77
dollars($100)or less PROPERTY OWNE OR AUTHORIZED AGENT
❑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 N
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 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 o Yes o No
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($300,000),IN occupant require a permit 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 ❑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) ❑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 25505 and 25534 concerning
Contractors 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 o 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 Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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 far a permit subjects the appliont 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
01,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.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 forthls 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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
a I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,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.
CERTIFICATE OF OCCUPANCY TENANT DISCLOSURE FORM
`Menifee
DATE Jq— 3 —2 o / 7 PERMIT NUMBER ( � J
ADDRESS 2 687,9 CA, eir /,////S Z eua.-cl'
BUSINESS NAME m4 -e—�ate
INTENDED BUSINESS USE
IS THIS A NEW BUSINESS IN THE CITY OF MENIFEE? ES NO (CIRCLE ONE)
ARE YOU THE FIRSTTENANT TO OCCUPY THIS SPACE? YES NO (CIRCLE ONE)
IS THE BUILDING EQUIPPED WITH FIRE SPRNKLERS? YES NO (CIRCLE ONE)
SQUARE FOOTAGE /Z( 3
NUMBER OF EMPLOYEES C�
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 OVER S' 9" HIGH?
YES (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
PRINT NAME
TENANT / OWNER / CONTRACTOR / ARCHITECT / ENGINEER (CIRCLE ONE)
OCCUPANCY GRP TYPE OF CONST STAFF INITIALS
APO:':5;�- 33�,o- 0I le 2
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
.^J
CERTIFIC TE OF OCCUPANCY APPLICATION
Menifee
DATE - 3 7 PERMIT NUMBER
t 1 u eu.o
BUSINESS NAME iN 97�gL? .S �/0JW SF Jaeil a/I64V 'ryq TYPE OF BUSINESS
ADDRESS a b.?7Y 0-he;6r /ai//S ,oul'aWIV
NAME OF BUSINESSOWNER(S) H/3'4114 Q)/A4t5-0
ADDRESS(IF DIFFERENT FROM ABOVE)
PHONE C Co Z-) 3 q(? — 6 EMAIL HAJ-14,¢7010'(Ei.%!2 fwf «�
OWNER OF BUILDING 54e-P h&IV Y"/ •-a .-VeY
ADDRESS
PHONE '/'5/_ c/�/0—�� EMAIL
DESCRIBE EXACT USE OF BUILDING:
PREVIOUS USE OF BUILDING/SUITE
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, 1 e/,4Csf id I f1.✓4e/>J . hereby agree to comply with the above-described terms in this
Application for
Certificate of Occupancy. /
��" 'f /� DATE - —3—?0/7
APPLICANT
CITY STAFF USE ONLY AND DATE
BUS LICENSE DATE HEALTH DEPT DATE
BUS LIC.NUMBER FIRE DATE
PLANNING DATE EMWD DATE
ENGINEERING DATE BUILDING DATE
ENGINEERING INSPECTION(INCLUDE VERIFICATION OF BMP'S BUILT PER PLANS/WQMP)
REF WQ/SW# APPROVED BY DATE
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.citycfinenifee.us Inspection Request Line
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