PMT17-04109 City of Menifee Permit No.: PMT17-04109
29714 HAUN RD.
�CCEL/� MENIFEE,CA 92586 Type: Commercial Alteration
MENIFEE Date Issued: 1111512017
PERMIT
Site Address: 29826 HAUN RD 104, MENIFEE,CA Parcel Number: 336-380-055
92586 Construction Cost: $0.00
Existing Use: Proposed Use:
Description of HOURLY INSPECTION FOR CERTIFICATE OF OCCUPANCY FOR SILVER LINING TRAVEL
Work:
Owner Contractor
AMBER MANAGEMENT SILVER LINING TRAVEL
29826 HAUN RD 29826 HAUN RD SUITE 104
MENIFEE,CA 92584 MENIFEE,CA 92586
Applicant License Number: 17-PEOP-00035
GERALD HAGAN
SILVER LINING TRAVEL
29826 HAUN RD SUITE 104
MENIFEE, CA 92586
Phone:6263946266
Fee Description Qtv Amount($1
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 contractors)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 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 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.leeinfo.ca.zov/calaw.htm 1.
this permit is issued.
Policy If Date
PROPERTY OWNER OR AUTHORIZED AGENT
❑I have and will maintain workers compensa.bon 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 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 relating to
buil 'n construction l authorize representatives of this city or county to
Policy# Expires ente t e abov de ied property for inspection purpose .
(This section need not to be completed is the permit is for one-hundred ,i Date
dollars($100)or less PRO E TY OWNER0 AU ORIZED AGENT
a-certify-that-in-the-performanceofthe-work for-which-this-permit-isiswed, - -- ---—
I shall notnot 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
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN Will the intended use of the building by the applicant or future building
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction modification from South
IN SECTION 3706OF THE LABOR"CODE;INTEREST,AND-ATTORNEYS-FEES'— Coast Air Quality Management District(SCACLMD)D)75ee permitting checklist -
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 forthe 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
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed nextto the applicable item(s)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to oyes o No
Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant forthe permitto 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 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.eoa�ov/lead/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-SOD-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. o No EPA Lead-Safe Certified Firm is required for this project because:
❑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.
CE`1;v-iCATE OF OCCUPANCY & TENANT DISCLOREAPPLICATION
Men ifee
DATE �� )
FNAME(S)
NAME SILVE� L-hV (N � EL
ADDRESS 2ggsa fltiN gyp, - SvI TF
OF BUSINESS OWNERS l..>E/XAupUMBER �G24�'�g1� G,2(e� CEu EMAIL or-1
OWNER OF BUILDING N
OWNER OF BUILDING ADDRESS
INTENDED BUSINESS USE Tmvejew OU
FS
IS THIS A NEW BUSINESS IN THE CITY OF MENIFEE? YES NO (CIRCLE ONE)
ARE YOU THE FIRST TENANT TO OCCUPY THIS SPACE? YES N� (CIRCLE ONE)
IS THE BUILDING EQUIPPED WITH FIRE SPRNKLERS? YES NO (CIRCLE ONE)
SQUARE FOOTAGE 15� NUMBER OF EMPLOYEES 3
NUMBER AND LOCATION OF RESTROOM FACILITIES m— F D 7-10 tZ
• LIST ANY TOXIC CHEMICALS,FLAMMABLE/COMBUSTIBL LIQUIDS OR GASE USED OR
STORED WITH MSDS SHEETS AND QUANTITIES OF EACH BELOW OR ON A SEPARATE
ATTACHED SHEET(S):
FActa
ARE YOU MAKING ANY IMPROVEMENTS TO THE SUITE OR BUILDING OTHER THAN PAINTING,
APERING, FLOOR COVERING, MOVABLE CASES, SHELVING OR PARTITIONS NOT OVER 5'9"
HIGH?
YES NO (CIRCLEONE)
t agrees that the Certificate of Occupancy shall be posted in a conspicuou cation,and will
ubject to thel Ciity'issuance of the Certificate of Occupancy.
1, hereby agree to comply with the above-
described terms irlthis Application of Certificate of Occupancy.
SIGNATUREL`` DATE // /j /7
APN 3,RCe " PERMITNUMBER _
INVOICE AMOUNT I OCCUPANCY GROUP
Cit I of Menifee BLIU lrng &safety l=eper:are , 29714 Na. i
w!ro vacityafrnenife�. s Inspection Request Line 951-246-CZ13