PMT17-01284 City of Menifee Permit No.: PMT17-01284
29714 HAUN RD. Type: Commercial Alteration
�CCEL/-> MENIFEE,CA 92586
MENIFEE Date Issued: 0511012017
PERMIT
Site Address: 28087 BRADLEY RD, MENIFEE, CA Parcel Number: 337-302-009
92586 Construction Cost: $450.00
Existing Use: Proposed Use:
Description of INSTALL 12'6"WALL AND 12'WALL TO DIVIDE SUITE
Work:
Owner Contractor
PRIME PROPERTIES C/O HUB ENTERPRISE MENIFEE SUPPLEMENTS
29826 HAUN ROAD,#305 28087 BRADLEY RD
MENIFEE, CA 92586 MENIFEE, CA 92586
Applicant Phone:8054163424
MENIFEE,CA License Number:0
Fee Description QtV Amount I51
Building Permit Issuance 1 27.00
Inspections not specified 258 258.14
Additional Plan Review Building 129 129.07
Additional Plan Review Building 129 129.07
GREEN FEE 1 1.00
SMIP COMMERCIAL 1 1.00
$545.28
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_PermiLTerrplate.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)pursuantto the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contactors 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 far 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 workers 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 Labor Code,for the performance of work for which WWW.Ieginfo.ca.gov/calaw.litml.
this permit is issued.
Policy# 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
Carrier with all applicable city and county ordinances and state laws relatingto
building construction.I authorize representatives of this city or county to
Policy# Expires enterth ab ntified/prro/perty for inspection purposes.
(This section need not to be completed is the permit is for one-hundred / !L!� 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 shall not employ any persons in any manner so as to become subject to 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,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 ❑Yes ❑No
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 HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 37060F THE
HE LABOR
ABOR 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) D 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
Contractor hazzardou
s License Law for the reason(s)indicated below by the Health al Safety Code,Section 25505 and 25534 concerning
hazardous
checkmark(s)I have placed next to the applicable Rem(s)(Section 7031.5 hs material reporting.
°Yes °No
Business and Professions Cade).Any city or county that requires a permit to
Date
construct,alter,improve,demolish or repair any structure,priorto its
PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permitto file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRPI
License Law(Chapter 9(commencingwith Section 7000)of Division 3 of the
Business and Professions Cade)arthat 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 ply w78
an Applicant for a permit subjects the applicant to a civil penalty of not more residenceorchildcares inclluesity to hetal propertyfied firmsandcomplywith
than($500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
❑I,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 1-8o0-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of 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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑1,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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE 00 '(fj PERMIT/PLAN CHECK NUMBER
TYPE: b COMMERCIAL O RESIDENTIAL O MULTI-FAMILY 0 MOBILE HOME O POOL/SPA O SIGN
fee
SUBTYPE: O ADDITION "OALTERATION O DEMOLITION O ELECTRICAL O MECHANNAiding &Safely Dept.
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES 017
DESCRIPTION OF WORK VLJL -t j
L S 7 ,� ed
PROJECTADDRESS Q LJr
ASSESSOR'S PARCEL NUMBER - - LOT TRACT
OWNER NAME o h VAY1 c Gffiew. N i1�'
ADDRESS ( s5 IvNj � "aim
PHONE Ctoq-Cpq�3 -�25� EMAIL
APPLICANT NAME
ADDRESS Z n C C
1
PHONE C ' 65� y Q21.' EMAIL C�!'
CONTRACTOR'S NAME OWNER BUILDER? YES O NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SO FT L SQ FT
APPLICANT'S SIGNATURE DATE 6c"� 1 �5
OTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP h
INVOICE 1 PAID AMOUNT O
AMOUNT OCASH CHECKq OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213