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PMT17-02945 City of Menifee Permit No.: PMT17-02945 29714 HAUN RD. -1:ACCEL!\? MENIFEE, CA 92586 Type: Commercial Alteration MENIFEE Date Issued: 08/18/2017 PERMIT Site Address: 29683 NEW HUB DR, Suite#C, MENIFEE, Parcel Number: 336-380-017 CA 92586 Construction Cost: $0.00 Existing Use: Office Proposed Use: Description of HOURLY INSPECTION FOR CERTIFICATE OF OCCUPANCY FOR"DIGITAL DENTAL LEADERS, LLC" Work: Owner Contractor AMBER MANAGEMENT, LLC DIGITAL DENTAL LEADERS, LLC 29826 HAUN ROAD,#305 29683 NEW HUB DR STE C MENIFEE, CA 92586 MENIFEE, CA 92586 Applicant Phone: 8444463444 MICAH TALBERT License Number: 17-PEOP-00026 DIGITAL DENTAL LEADERS, LLC 29683 NEW HUB DR STE C MENIFEE, CA 92586 Phone: 8444463444 Fee Description Oft Amount($) 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 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_Permit_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 C ❑I am exempt from licensure under the Contractor's State License Law for hapter9(commencing with section 7000)of Division 3 of the Business and 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 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.html. this permit is issued. Date Policy# PROPERTY OWNER OR AUTHORIZED AGENT ❑I 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 ❑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 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# Expires enter the above identified property for inspection purposes. n (This section need not to be completed is the permit is for one-hundred r)J, Date 1 dollars($100)or less ROPERTY 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 worker's 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 mixture containing a hazardous material equal to or greater that the Applicant Date 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 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 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 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 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 ❑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. ov 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 Contractor's 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 ❑No EPA Lead-Safe Certified Firm is required for this project because: not built or improved for the purpose of sale. ❑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. 41-1 M e n i f e e + 1� •� ii DATE BUSINESS NAME j n\ UCH. io- LeaA -s LL C v BUSINESS ADDRESS 23 �9 3 N e., µ D r S C } C NAMES)OF BUSINESS OWNERS (\k,n!J �e' -A PHONENUMBER Com- OWNER OF BUILDING )be, �� 2,t��- LLC OWNER OF BUILDING ADDRESS 19 �2 b J-6 -he- 30 S y ' 172 INTENDED BUSINESS USE -c- nCe- 'L IS THIS A NEW BUSINESS IN THE CITY OF MENIFEE? ES NO (CIRCLE ONE) ARE YOU THE FIRST TENANT TO OCCUPY THIS SPACE? YES NO (CIRCLE ONE) IS THE BUILDING EQUIPPED WITH FIRE SPRNKLERS? YES , NO (CIRCLE ONE) SQUARE FOOTAGE (O�� NUMBER OF EMPLOYEES NUMBER AND LOCATION OF RESTROOM FACILITIES O o e- — F:�f-s•-+ • 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): ' � 9 • ARE YOU MAKING ANY IMPROVEMENTS TO THE SUITE OR BUILDING OTHER THAN PAINTING, PAPERING, FLOOR COVERING, MOVABLE CASES,SHELVING OR PARTITIONS NOT OVER 5'9" HIGH? YES (CIRCLE ONE) Applicant agrees that the Certificate of Occupancy shall be posted in a conspicuous location, and will operate subject to the City' issuance of the Certificate of Occupancy. I, F (-1 L --FczLl I- , hereby agree to comply with the above- described terms in Ap icatio Certificate of Occupancy. SIGNATURE DATE A P N ?J �cV 3� ^o ` PERMIT NUMBER f4 i` opolV5- INVOICE AMOUNT (-5(0• OCCUPANCY GROUP f5 C;t,l of Menij 2_ ' liio'ing&Safety Department 797T14 Houn R ieni;ee, C ?_: iVLlb'✓.C/t)✓J%'?ei711��._h i7S�2C'/JI) �2(JLfC'� Llli?951 24 ;� 1 ➢<< � �\ oo _y I11 — O 01 0 ® ° ® cD v A9 G F 2 U) (D3 co cif co 0- 4 O) O O ^o0 � (Dcs' oo c 0-cc ➢�r' j1% Q CA) (Do CA v :3 O c n MI � " } � o E o u) — (D C Fly cs (D p (D O O z z �y j{ ooe J•( (D 3 C O 3 —n Cl) (D C: ti jE rn J N O Q. O `'` A Q. •.� C z h (D In C-) 0 co { U CTI ® (a � �' a„ all r °a ° O O (D J N vl . 1 00 r W A Ol (� �. co r. u' �9��C��E��l}C�'��GA�`�� 1��9.�� ' '�.C� Ji\''��-1.`.�.��aC��-'�.�'�•9 `�,1 `Gs�/.�� `V'y �`:5'f�r ��C.-'��,