PMT18-01615 City of Menifee Permit No.: PMT18-01615
29714 HAUN RD.
�CCELJ MENIFEE,CA 92586 Type: Commercial Alteration
MENIFEE Date Issued: 04/09/2018
PERMIT
Site Address: 27271 ETHANAC RD,Suite#104, Parcel Number: 331-110-030
MENIFEE, CA 92585 Construction Cost: $0.00
Existing Use: Proposed Use:
Description of HOURLY INSPECTION FOR CERTIFICATE OF OCCUPANCY FOR"LOS CUSTOMS"AUDIO AND
Work: WINDOWTINTING SHOP
Owner Contractor
NEMAX INC LOS CUSTOMS
22498 WHIRLAWAY CT 27271 ETHANAC RD SUITE#104
CANYON LAKE,CA 92587 MENIFEE,CA 92585
Applicant Phone:9512297797
CARLOS MEDINA License Number: 18-PEOP-00013
LOS CUSTOMS
27271 ETHANAC RD SUITE#104
MENIFEE, CA 92585
Phone:9512297797
Fee Description QQt rr Amount tSl
Assistant Fire Marshal Fee 1 162.00
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
$318.07
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_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
I hereby affirm under penalty of perjurythat I am under provisions of with a licensed contractors)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and in I am exempt from Iicensure under the Contractor's 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 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
this permit is issued. www.le infucaa./ovv/calalaw.html.
Policy# / `� — Date ru
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 in 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
building construction.I authorize representatives of this city or county to
Policy# Expires enter the above Identified property 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
D I certify that in the performance of the work for which this permit is issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of Califomia,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 spfcified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes NNo
UNLAWFUL,AND SHALLSUBIECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use ofthe building bythe 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 forguideliges
CONSTRUCTION LENDING AGENCY ❑Yes 120
1 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) oyes -a/No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that am exempt from the Permitting checklist.I understand my requirements under the State of
California Health al 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 item(s)(Section 7031.5
Lsl�es gtlo
Business and Professions Cade).Any city or county that requires a permit to C%L/ Date ci 4 Cl 0
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 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 Iicensure 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 perm?[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
o 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 I I 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 1-800-424-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 RAP rule please fill out the RRP
Acknowledgement.
CERTIFICATE OF OCCUPANCY APPLICATION
WIN
4!
�� `Menifee
DATE C/�/�� PERMIT NUMBER?� 11 V DI��
BUSINESS NAME LGS Gljyg x,.S TYPE OF BUSINESS tl� ,h e lTrl�i
ADDRESS M-71 9,41n-%nm V,4 AO I 00nolTre2 1, CA 2/129
NAME OF BUSINESS OWNER(S) 00� IG c Med(Inom
ADDRESS((IF DIFFERENT FROM ABOVE) //
PHONE R) )22g— 7-7G'7 EMAIL 66SCIcL�t�A Con
OWNER OF BUILDING ?lee�l y r o c)u-c /Vet,ox -Too
ADDRESS
PHONE (gsl)26s 2.L/12 EMAIL
DESCRIBE EXACT USE OF BUILDING: /t✓dIU t wi,,da,,/Ink
PREVIOUS USE OF BUILDING/SUITE 'M-f Sh d'o
APPLICANT ACKNOWLEDGEMENT
Applicant agrees that the Certificate of Occupancy shall be posted in a conspicuous location, and will operate subject
to the City's issuance ®of the Certificate of Occupancy.
I, CP/�aS rntJ1Ha , hereby agree to comply with the above-described terms in this
Application for Certificate of Occupancy.
Z�� DATE Oy/�Q IF
APPLICANT
CITY STAFF USE ONLY AND DATE
BUS LICENSE DATE ENGINEERING DATE
BUS LIC.NUMBER Cy FIRE DATE
PLANNING f /� DATE / /�C) EMWD DATE
HEALTH DEPT DATE BUILDING DATE
REMARKS
City of Menifee Building & Safety Department29714 Houn Rd. Menifee, CA 92586951-672-6777
www.citycfinenifee.us Inspection Request Line
CERTIFICATE OF OCCUPANCY TENANT DISCLOSURE FORM
„
`- Menifee
r
ADDRESS I-Fee G2S
BUSINESS NAME
INTENDED BUSINESS USE a A ow ivt�i
IS THIS ANEW BUSINESS IN THE CITY OF MENIFEE? NO (CIRCLE ONE)
ARE YOU TH E A RST TENANT TO OCCUPY THIS SPACE? YES NO (CIRCLE ONE)
IS THE BUILDING EQUIPPED WITH FIRE SPRNKLERS? ES NO (CIRCLE ONE)
SQUAREFOOTAGE I3GO -r
NUMBER OF EMPLOYEES
NUMBER AND LOCATION OF RESTROOM FACILITIES
LIST ANYTOXIC CHEMICALS, FLAMMABLE/COMBUSTIBLE LIQUIDS OR GASES USED OR STORED WITH
MSDS SHEETS AND QUANTITIES OF EACH BELOW OR ON A SEPARATE ATTACHED SHEET(S):
• ARE YOU MAKING ANY IMPROVEMENT 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 SHALL OBTAIN ALL REQUIRED CLEARANCES AND/OR APPROVALS FROM THE
APPROPRIATE WATER DISTRICT AND FIRE DEPARTMENT PRIOR TO ISSUANCE OF ANY
BUILDING PERMITS
�
SIGNATURE �i/�L% ' DATE 0jZ0q
PRINT NAME
ENA / OWNER / CONTRACTOR / ARCHITECT / ENGINEER (CIRCLE ONE)
FOR CITYSTAFF I PERMIT NUMBER
OCCUPANCY GRP TYPE OF CONST I STAFF INITIALS
J!�Okok� (14I540•° 1 361-tIC-05! >
r_ov-� Ito COX-
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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