PMT18-02100 City of Menifee Permit No.: PMT18-02100
29714 HAUN RD.
4fICCEL/�1. MENIFEE,CA 92586 Type: Commercial Alteration
Gw.m-ie•.e 8+1Me MENIFEE Date Issued: 0 5101/2 01 8
PERMIT
Site Address: 29798 HAUN RD,Suite#100,MENIFEE, Parcel Number: 336-381-025
CA 92586 Construction Cost: $0.00
Existing Use: Proposed Use:
Description of HOURLY INSPECTION FOR NEW HOPE PHARMACY C OF O
Work:
Owner Contractor
KIM NGUYEN
15622 BROOKHURST ST
WESTMINSTER,CA 92683
Applicant License Number.
MENIFEE,CA
Fee Description -0—ty Amount(51
Special Inspection 1 126.00
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
$282.07
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 buiiiding operations being carded on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise staled,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
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law)-
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑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 1 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
D 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 forworker'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.permit is issued.
Policy q Date
❑I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which D By my signature below 1 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 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 R Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred J GAci L Date
dollars($100)ar less PROPERTY OWNER PR AUTHORIZED AGENT
❑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 R
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 37GO of the Labor
Cade,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 15 D Yes O 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 D Yes D 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 o 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
Contractor's License Law for the reason(s)indicated below by the California Health al Safety Cade,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes ❑Na
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 OWN ER 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 LRRPI
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 permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
D I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eoa-eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5373).
Code;The Contractor's State License Law does not apply to an owner of a D An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 70",Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
City of Menifee
Building Dept.
MAY 0 1 2018
Menifee
N _ �L -ate/ Deceived
DATE L/ S /a�/�� PBWITNUMBER. >1 \\ %00
BUSNESSNAME zvoij mee� n�/-�r BU9NESS �i
ADDFEBS 7,4 /�J 2�t Y/�i zSd6
NAMEOFBU9NESOMM,c) NC/�L�l 1I4' dLf
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PHONE�l ) 4 �f -OJ S7 EMAIL T Nf.�J/�H7i��BZXB Cr�i�,
OWNER OFEIUILDING
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PFiElAOUSUEEOFBUILDING'SJITE
APPUCANTACKNOWL®C$NENT
Applicant agrees that the Certificate of Occupancy shall be posted in a conspicuous location,and will operate subject
to tIAOtCTIM-16nce of the Certificate of Occupancy.
1, �A ucfk E is cou`c€r� .hereby agree to comply with the above-des ribed terms in this
Application for ICertificate of Occupancy.
V Gil eu'C a—� DATE S I - I d
JAPP�CANT
BUSUCENM DATE ENGINEERING DATE
BUSUC NUMBER RRE DATE
PLANNING DATE Ev1WD DATE
HEALTH DEPT DATE BUILDING DATE
REMAFM
City of Menifee Building&%fety Department 29714 Flaun Pd.Menifee,CA 92586 951-672-6777
www.atyofinenifee.usInspection Request Line
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DATE Y—( _ ($ PEIWITNUMBER
ADDRESS 2- ARAM ( -o oo M-C61i FtE
BUSNESSNAME NC- L% RM Pf CA(
INTENDEDBUSNESSUSE �TAic_ AC Y
ISTHISANEWBUSNESSINTHEQTYOFmENiFEE? YES NO (OMEONq
AREYOUTHEHRSTTENANTTOOOMPYTHISEPACE? YID (MaEONq
ISTHEBUILDINGEQUIPP®WITH RFESPI 4M? NO (arazEoNq
SDUAREFOOTAGE vqG 0
NUM BEROF Ev1 PLOYEES
NUMBERANDLOC -lONOFFM7ROOM FAOUTIES
USTANYTOMCCHEMICCL RAM MABURCOMBUSIIBLEUQUIDSORG4EES USED ORSfCMREDWITH
M SDSSHEIEHSAND QUANTMESOF EACH BELOW OR ON A SEFARATEATTAaR®S-EIFRS):
.; AFEYOUMA INGANYIMPROVEMENTTOTHESUITEORBUILDINGOTHERTHANPAINTINQ
PAF9aNC FLOOROJVBRNQ MOVABLECAg$ 9iEVINGOR PARTITIONS NOT Oy 5' S' HIGH?
YES NO (aFE EONq
MI APPLICANTS-ALL OBTAIN ALL F;EQuiRIDCLEARfWCsAND/ORAPPFZOVALSFRDMTHE
APPRUPRATE WATERDISTRICTAND RRE DE'ARIM ENT PRORTO IS9JANCE OFANY
BUILDINGPEFMITS /
SIGNATUFE Aim e�- DATE f 1( ( Q
PRNTNAME V Lv-MiC tLCcu�fcrl
TEJANT I O✓VNE2! aWMCfOR/ ARLT-0= BJG NMR (CMEONE)
OOaJPANCYGP TYPEOFcoNST STAFFINITIALS
aty of Menifee Building&83fety Department 29714 Faun F d.Menifee,CA 92586 951-672-6777
www.dtyofinenifee.us Inspection Request Line 951-246-6213
Riverside County Fire Department IFire Protection Planning Section
Riverside ORre:2300 Madcet St.Ste,150,Riverside,CA 92501 Ph.(951)9554 7 Fax(951)9554888
Palm Desen Office: 77-933 Las Montana,Rd.,a 201 Palm Desert,CA 92211-4131 Ph.(760)863 8886 Fax(760)863-7072
Fire Department Clearance/Release
Date: 06/05/2018
To: ccarlsonna cityofinenifee.us briveraCoDcitvofinenifee.us: mbinnall(cDcityofinenifee.us: Pwinters@citvofmenifee.us
Tract/Parcel Map#: 384-0701-026
Pe rm it/Lot#: 18-M E N I-02100
Job Site Address: 29898 Haun Rd. #100, HOPE PHARMACY
❑ Final For Recordation
❑ Release For Building Permit(s)
❑ Shell Final Only (No Tenant)
Final For Occupancy
❑ Release For Residential Sprinkler Installation
❑ Building Plan Check Fees Paid, Water Requirement Met-if waterapplicable
❑ Building Plan Check Fees Not Paid
Residential Sprinkler Plan Check Fees Paid
Residential Sprinkler Plan Check Fees Not Paid
❑ Other Fees
❑ Fees Not Required
This business occupancy has been inspected for compliance to Fire-Life Safety requirements and conditions and is
approved for occupancy by the Office of the Fire Marshal.
If you should have any questions, please contact the appropriate Riverside County Fire Protection Planning office for
further assistance.
Paul Villalobos, AFM
Print Name of Plan Reviewer/Inspector Approved Release
Paul Villalobos,AFM
Sent By: Print Name
Form C—Revised 3101/2012
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