PMT18-02695 City of Menifee Permit No.: PMT18-02695
29714 HAUN RD.
r MENIFEE, CA 92586 Type: Commercial Alteration
MENIFEE MENIFEE Date Issued: 06/04/2018
PERMIT
Site Address: 26878 CHERRY HILLS BLVD, MENIFEE, Parcel Number: 337-320-016
CA 92586 Construction Cost: $0.00
Existing Use: Proposed Use: Office
Description of HOURLY INSPECTION FOR CERTIFICATE OF OCCUPANCY FOR'TLC DOCUMENTS&NOTARY
Work: SERVICES"
Owner Contractor
CHERRY HILLS PLAZA TLC DOCUMENTS& NOTARY SERVICES
P.O. BOX 643 26878 CHERRY HILLS BLVD
MENIFEE, CA 92586 MENIFEE,CA 92586
Applicant Phone:9514903468
EMMA HERRERA License Number: 18-PEOP-00019
TLC DOCUMENTS&NOTARY SERVICES
26878 CHERRY HILLS BLVD
MENIFEE, CA 92586
Phone:9514903468
Fee Description Qty Amount f8)
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 building operations being caffied 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 o I am exempt from licensure 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
o 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 70"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.IeRinfo.ca.Rov/caIavv.htmI.permit is issued.
Policy g Date
❑1 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 ❑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
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 p Expires �r the above identified pro inspection purposes. �(
(This section need not to be completed is the permit is for one-hundred �' Date V
dollars($100)or less ERTY OWNER OR AU HORIZED AGENT
o 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 K
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 an the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o 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 o Yes o No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 30D0 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) o Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
1 hereby affirm under penalty of perjury that I 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 reasons)indicated below by the
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5
Business and Professions Code).Any city or county that requires a permit to oyes ❑No
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 Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRPI
License Law(Chapter 9(commencing with Section 7D00)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.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:
o 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: PERMIT/PLAN CHECK NUMBER D� a
PLANNING CASE NUMBER
TYPE: 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 0 RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK '( '\�C.(,�J\\Ci 3 4 Q✓eoay-41cvi
PROJECTADDRESS CUYvq `VW 16`Va ZIP 9L )' p
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
ADDRESS
PHONE EMAIL
APPLICANTNAME if
ADDRESS G-� 2d ?oAl c,
t
C' /n�'
PHONE 5 j L J J O �0:7! EMAIL WA 1 I oo C 61(
CONTRACTOR'S NAME OWNER BUILDER? O YES O NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SO FT L SO FT
APPLICANT'S SIGNATU /IC". DATE
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL 15� 0'? GREEN SMIP �-
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
GYVE{®* tluilding &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
Building Dept. www.cityofinenifee.us
JUN 0 4 2018 NIF
Received
E OF OCCUPANCY TENANT DISCLOSURE FORM 0 1
Menifee
Ad
DATE U PERMITNUMBER 'Up2 �' S
ADDRESS Z� �( 1 lJ 3UV\ Cl bZ C(.1
BUSINESSNAME TU(`` , Sel(C)tces
INTENDED BUSINESS USE
IS THIS A NEW BUSINESS IN THE CITY OF MENIFEE? YES NO (CIRCLE ONE)
ARE YOU THE FIRST TENANT TO OCCUPY THIS SPACE? E5 NO (CIRCLE ONE)
IS THE BUILDING EQUIPPED WITH FIRE SPRNKLERS? YES NO (CIRCLE ONE)
SQUARE FOOTAGE
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 05,9" HIGH?
YES NO (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
SIGNATUR DATE
PRINT NAME 2 kf
TENANT OWNER / CONTRACTOR / ARCHITECT / ENGINEER (CIRCLE ONE)
OCCUPANCY GRP TYPE OF CONST STAFF INITIALS
5co. a-7 3'S77'
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92585 951-672-5777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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