PMT17-04032 City of Menifee Permit No.: PMT17-04032
29714 HAUN RD. Type: Commercial Alteration
�1-�CCEL./-> MENIFEE,CA 92586
MENIFEE Date Issued: 11/09/2017
PERMIT
Site Address: 27090 NEWPORT RD,MENIFEE, CA Parcel Number: 336-180-026
92584 Construction Cost: $30,000.00
Existing Use: Proposed Use:
Description of SPECIAL INSPECTION TO ASSESS DAMAGE CAUSED BY FIRE FOR"STATEWIDE MINISTORAGE
Work: MENIFEE"
Owner Contractor
STATEWIDE MINISTORAGE MENIFEE L&E ASSETS INC
19800 MACARTHUR#300 1350 DAISY AVENUE
IRVINE, CA 92612 LONG BEACH, CA 90813
Applicant Phone:5625911788
DARRIN TOMASICK License Number:946841
SERVPRO OF DOWNTOWN LONG BEACH
1350 DAISY AVE
LONG BEACH, CA 90813
Phone:7149801639
Fee Description O_yt Amount 4$1
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
$166.07
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_Bidg_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 contractors)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjurythat I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑1 am exempt from licensure under the Contractor's State License Law for
Professions Code and
/myyclicense Is In full force and effect. the following reason:
License Class 44664( U ns o. By my signature below I acknowledge that,except for my personal residence
Expires 3( 8 Signatur 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.htmi.
this permit is issued. d /'
Policy it (N� D2 O SC�-3 Date
PROPERTY OWNER OR AUTHORIZED AGENT
❑I have and will maintain worker's compensation insurance,as required by
section 37DO 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 .-7 R building construction.I authorize representatives of this city or county to
Policy# Expires / - ' - ( `� enterthe above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I cert! that in the performance of the work for which this permit is Issued,
I shall nat emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the w Fh
mpensation provisions of Section 3700 of the Labor
Code,I shall fo mply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Q mixture containing a hazardous material equal to or greater that the
Date Applicant amounts Lfied on the Hazardous Materials Information Guide?
WARNING: ILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes XNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES WIII 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 perm it 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 WW .
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 boHndary of a school?
(Section 3097 Civil Code) ❑Yes yL`1,-f,',�.,
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&Safe Code,Section 25505 and 2SS34 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous mat a ep ing.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 s ❑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 O UTHORIZED 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 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 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
❑1,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-BOG-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
not built or improved for the purpose of sale. o 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 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 RAP
Acknowledgement.
, � . •
Y
� Menifee
DATE: PERMIT/PLAN CHECK NUMBER
TYPE: �c COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK F'lk E 7fic -
Sl �l
PROJECTADDRESS �L(,/P�D � q ZIP
ASSESSOR'S PARCEL NUMBER i)%/�o '�O✓' LOT - / TRACT
OWNER NAME
ADDRESS 2` Z
PHONE EMAIL
APPLICANTNAME /�
ADDRESS I 'Y •/'t � +
PHONE 7l q) evV 'i 63R EMAIL CPS -5azvmA L-.Br—.4�OA l
CONTRACTOR'S NAME E EDOrc OWNER BUILDER? AYES ONO
BUSINESS NAME
ADDRESS
PHONE //33'' ///��y�/EMAIL
CONTRACTOR'S STATE LIC NUMBER q` & 3 1 LICENSE CLASSIFICATION
VALUATION $ 43D Oa SO FT L SQ FT
APPLICANT'S SIGNATURE DATE
LTYS.TAFF.USEONLY.--
DEPARTMENT DISTRIBUTION /�►7O/ CITY OF MENIFEE BUSINESS LICENSE NUMBER
ACCEPTED BY: - �'(//�_/ /
BUILDING PLANNING ENGINEERING FIRE �y
PERMIT FEE 1 C�. 1 SMIP GREEN
PLAN CHECK FEE INVOICE TOTAL
OWNERBUILDERVERIFIED BYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd�Menifee, CA 92586 951-672-6777
\`\ www.cityofmenifee.us