PMT17-01375 City of Menifee Permit No.: PMT17-01375
29714 HAUN RD. Type: Commercial Alteration
�ACCELA—> MEN IFEE, CA 92586
MENIFEE Date Issued: 05/02/2017
PERMIT
Site Address: 28125 BRADLEY RD,Suite#250, Parcel Number:
MENIFEE,CA 92586 Construction Cost: $0.00
Existing Use: Proposed Use:
Description of HOURLY INSPECTION FOR C OF O"NEW ACTON MOBILE INDUSTRIES, LLC"
Work:
Owner Contractor
BRADLEY MEDICAL ASSOC
28125 BRADLEY ROAD
MENIFEE,CA 92586
Applicant License Number.
MENIFEE,CA
Fee Description City Amount 1E1
Building Permit Issuance 1 27.00
Inspections not specified 129 129.00
$156.00
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_131dg_Pennit_Template.rpt Page 1 of 1
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 ❑I am exempt from licensure under the Contractors State License Lawfor
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 m g p my personal residence
Expires Signature in which 1 must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legallysell 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 ,hyryr le¢info.ra.eov/calaw.html.
this permit is issued.
Policy R Date
o 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 identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date24-
dollars($100)or less PBRTY 01NNE UTHORI D GA ENT
D 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 p
workers compensation laws of California,and agree that if I should became 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 o 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 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 o 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 a 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
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 items)(Section 7031.5
oyes ❑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 IRRPI
License Law(Chapter 9(commencing with Section 7000)of Division 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 ply w78
an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to be rental
propRRIP-certertyfied 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 ,
❑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.eoa.aov/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
p D 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. a 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 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.
CER�TIFICATE OF OCCUPANCY APPLICATION
Menifee
03/29/17
DATE PERMIT NUMBER
BUSINESS NAME New Acton Mobile Industries,LLC TYPE OF BUSINESS Leasing
ADDRESS 28125 Bradley Road Ste 250
NAME OF BUSINESS OWNER(S) Ingrid West,President
ADDRESS(IF DIFFERENT FROM ABOVE) 809 Gleneagles Ct.,Ste 300 Baltimore,MD 21286
PHONE 410-931-9100 EMAIL tax@actonmobile.com
OWNEROFBUILDING Bradley Medical Associates
ADDRESS 28125 BradleyRd,Menifee,CA 92586
PHONE 951-723-4041 EMAIL
DESCRIBE EXACT USE OF BUILDIfJG: Professional Office Building
PREVIOUS USE OF BUILDING/SUIFE Professional Office Building
APPLICANT ACKNOWLEDGEME
Applicant agrees that the Certific to of Occupancy shall be posted in a conspicuous location,and will operate subject
to the
City's issuance of the Certi ate of Occupancy.
I, lC Lc►1 CAPo�I� �2 I hereby agree to comply with the above-described terms in this
Application for Certificate,of Occ pancy. /
VP Q&2d,,< DATE
AP
CJTY,MrAFiUSE0NLX • DATE IPAPPROVED)
BUS LICENSE (DATE HEALTH DEPT DATE
BUS LIC.NUMBER {I FIRE DATE
PLANNING I DATE EMWD DATE
ENGINEERING DATE BUILDING DATE
ENGINEERING INSPECTION(INCLUDgERIFICATION OF BMP's BUILT PER PLANS/W4MP)
REF WQJSW v I APPROVED BY DATE
City of Menifee Bui! g 9,Safety Department 29714 Houn Rd. Menifee, CA 92585 951-672-6777
www.cityofinenifee.us Inspection Request Line
r
----------------
A Me nifee
DATE
3129/17 PERMIT NUMBER
ADDRESS 28125 Bradle Road,Ste 250
BUSINESS NAME New Acton Mobile Industries,LLC
INTENDED BUSINESS USE Professional office brilding
YES NO (CIRCLE ONE)
ISTHIS A NEW BUSINESS IN THE CITY OF MENIFEE? YE NO (CIRCLE ONE)
ARE YOU THE FIRST TENANT TO OCCUPY THIS SPACE? YES (CIRCLE ONE)
IS THE BUILDING EQURPED WITH FIRE SPRNKLERS?
SQUAREFOOTAGE 660
NUMBER OF EMPLOYEES
9
NUMBER AND LOCATIONOF RESTROOM FACILITIES Common sharedu stairs and downstairs
OR ST
MSDS SHEETS AND QUAIITI FLAMMABLE/COMBUSTIBLE D
LIST ANY TOXIC CHEMICXLS,TIES O E EACH BELOW OR ON A SEPARATE ATTACHEDSHEET(5)RED WITH
Not applicable
ARE YOU MAKING ANY IMPROVEMENT TO THE SUITE OR,BUILDING OTHER THAN PAINTING,
• �R COVERING,MOVABLE CASES,SHELVING OR PARTITIONS NOT 9" HIGH?
PAPERING, Fl ',YES NO (CIRCLE ONE)
• APPLICANT SHALL OBTAIN ALL REQUIRED CLEARANCES AND/OR APRRoVALS FROM THE
APPROPRIATE WATER DISTRICT AND FIRr�cIJARTMENT PRIOR TO ISSUANCE OF ANY
BUILDING PL ITS
SIGNATURE DATE S' /JI
PRINT NAME
TENANT/ OWNER / CONTRACTOR / ARCHITECT / ENGINEER (CIRCLE ONE)
s
OCCUPANCY GRP TYPE OF CONST STAFF INITIALS
City of Menifee Build &Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
ww cityofinenifee.us inspection Request Line 951-246-6213
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