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PMT18-02894 City of Menifee Permit No.: PMT18-02894 29714 HAUN RD. MENIFEE, CA 92586 Type: Commercial Alteration MENIFEE MENIFEE Date Issued: 06/1 212 01 8 PERMIT Site Address: 26800 NEWPORT RD, MENIFEE, CA Parcel Number: 338-170-019 92584 Construction Cost: $0.00 Existing Use: Proposed Use: Description of HOURLY INSPECTION FOR C OF O RIVER SPRINGS CHARTER SCHOOL BLDG D Work: Owner Contractor RIVER SPRINGS CHARTER SCHOOL 27740JEFFERSON AVE TEMECULA, CA 92590 Applicant License Number: RIVER SPRINGS CHARTER SCHOOL 27740JEFFERSON AVE TEMECULA, CA 92590 Phone:7603306176 Fee Description DIV Amount IS1 Administrative Fee 126 126.00 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 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 1 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 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 WORKER'S COMPENSATION DECLARATION Improvements covered by this permit.I cannot legally sell a structure that I 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 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 Cade,for the performance of work for which - this permit is issued, www.leeinfo.ca.eov/calaw.html. Policy N ` Date 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 oconst r ature below I certify to each of the following:I am the property this permit is issued.My workers compensation insurance carrier and polity horized to act on the property owners behalf.I have read this number are: a d the information I have provided is correct.I agree to comply Carrier lic le city and county ordinances and state laws relating to nst ion-l authorize representatives of this city or county to Policy 8 Expires bove entified propert for inspection purposes, (This section need not to be completed is the permit is for one-hundred 9r Date 1 dollars($100)or less PROPERTY OWNE THORIZED 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 g worker's 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 alms 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($100,0(l0),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(SCAQM D)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY ❑Yes o No I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be withln 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) D 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 California Health&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 items)(Section 7031.5 oyes D 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 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[RRP 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 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( )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. D 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 RAP Acknowledgement. Y �' Men'fee DATE:6/12/18 PERMIT/PLAN CHECK NUMBER NIA 1 TYPE: <,,"'C`OMMERCIAL O RESIDENTIAL O MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA O SIGN SUBTYPE: O ADDITION CALTERATION O DEMOLITION OELECTRICAL O MECHANICAL <, NEW 0PLUMBING RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK Re-painting, re-carpeting, general repairs City of Menifee PROJECT ADDRESS 26800 Newport Road,Building D(as shown on attachment A) ZIP Dept. ASSESSOR'S PARCEL NUMBER 338-170-019 LOT TRACTJUN 12 2018 OWNER NAME River Springs Charter School Received ADDRESS 27740 Jefferson Avenue, Temecula CA 92590 PHONE 760-330-6176 EMAIL dave.black@springscs.org APPLICANT NAME River Springs Charter School ADDRESS 27740 Jefferson Avenue, Temecula CA 92590 PHONE 951-252-8800 EMAIL dave.black@springscs.org CONTRACTOR'S NAME N/A OWNER BUILDER? 0 YES ONO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ SQ FT L SQ FT APPLICANT'S SIGNATURE DATE 6/12/18 CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY: PERMIT FEE ,0"1 SMIP 74- GREEN PLAN CHECK FEE INVOICE TOTAL O OWNER BUILDER VERIFIED 0 YES 0 NO DRIVERS LICENSE k NOTARIZED LETTER 0 YES 0 NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofmenifee.us CERTIFICATE OF OCCUPANCY TENANT DISCLOSURE • ' Y `,'--4 Menifee DATE 6/12/18 PERMITNUMBERN/A — u ADDRESS 26800 Newport Road, Building D (as shown on attached map BUSINESS NAME River Springs Charter School INTENDED BUSINESS USE 501(c)3 Public Charter School IS THIS A NEW BUSINESS IN THE CITY OF MENIFEE? YES of Nf lb@NE) ARE YOU THE FIRST TENANT TO OCCUPY THIS SPACE? YES idina�CTfkFMONE) IS THE BUILDING EQUIPPED WITH FIRE SPRNKLERS? ES N91JN 1 @IFNgNE) SQUARE FOOTAGE 3,300 pia® NUMBER OF EMPLOYEES 6 �iCIG+iv ed NUMBER AND LOCATION OF RESTROOM FACILITIES 8 as shown On attachment B LIST ANY TOXIC CHEMICALS, FLAMMABLE/COMBUSTIBLE LIQUIDS OR GASES USED OR STORED WITH MSDS SHEETS AND QUANTITIES OF EACH BELOW OR ON A SEPARATE ATTACHED SHEET(5): N/A • ARE YOU MAKING ANY IMPROVEMENT TO THE SUITE OR BUILDING OTHER THAN PAINTING, PAPERING, FLOOR COVERING, MOVABLE CASES,SHELVING OR PARTITIONS NOT OV 5' 9" HIGH? YES NO (CIRCLE ONE) • APPLICANT SHALL OB AIS ALL REQUIRED CLEARANCES AND/OR APPROVALS FROM THE APPROPRIATE WATER DISTRICT AND FIRE DEPARTMENT PRIOR TO ISSUANCE OF ANY BUILDING PE ITS `\ DATE 6/12/18 SIGNATURE PRINT NAME Dave Black TENANT / OWNE / CONTRACTOR / ARCHITECT / ENGINEER (CIRCLE ONE) CITYSTAFFUSEONLY OCCUPANCY GRP f TYPE OF CONST STAFF INITIALS City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 y � Building of Menifee Dept. JUN 12 2018 aReceived t ti • A L 51 . ! Y its . y r City of Menifee Building Dept. JUN 1��/2�++2018 w. e ... cel !Ie S p� Q s �(JD e a i N e p (gam a Q l •\� I'M;CIO a - Q "pl • i Q -75 � I _ � w (D s Y © eb } lr : FD 11±ly? 3 v m d 15 1 . 1 f