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PMT18-03313 City of Menifee Permit No.: PMT18-03313 29714 HAUN RD. MENIFEE, CA 92586 Type: Commercial Addition MENIFEE MENIFEE Date Issued: 0 8/1 012 01 8 PERMIT Site Address: 28400 MATTHEWS RD, MENIFEE, CA Parcel Number: 331-190-039 92585 Construction Cost: $15,000.00 Existing Use: Proposed Use: Description of INSTALL HIGH PILE STORAGE RACKS FOR BLOCK GRAPHICS Work: Owner Contractor BLOCK GRAPHICS INC T K SYSTEMS INC 1900 DALROCK ROAD 6949 BUCKEYE STREET ROWLETT,TX 75088 CHINO, CA 91710 Applicant Phone:9092873015 JOSE RODRIGUEZ License Number: 800845 T K SYSTEMS INC 6949 BUCKEYE STREET CHINO, CA 91710 Phone: 9092873030 Fee Description Oly, Amount($1 High Pile Floor or Rack Storage 1 348.00 Building Permit Issuance 1 27.00 Additional Plan Review Building 210 210.00 GREEN FEE 1 1.00 SMIP COMMERCIAL 1 5.00 New Construction Permit Fee 1 69.00 General Plan Maintenance Fee-New 1 3.45 Construction $663A5 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_Permil_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 licensure underthe Contractors State License Law for Professions Code and my license is full fycaand effe[,t. the fallowing reason: License Clas C- ,Z Licen . W 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 ❑I hereby affirm under penalty of perjury a f 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 www.leginfo.ca.gov/calaw.html.permit is issued. Policy 0 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 ❑By my signature below I 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 owner's behalf.I have read this number are: application and the information I have provided is correct.I agree to comply Carrier W/ with all applicable city and county ordinances and state laws relating to � � rrCCJ nn c� building c ction.I authorize representatives of this city or cou to Policy R wrT J brU Expires ente le above i ntified ro erty for inspection purp es. (This section need not to be completed is the per it! for one-hundred Date /V dollars($S00)or less ROPER WNE ORAUTHORIZEDAGENT ❑I certify that in the performance of the work for which this permit Is issued, I shall not employ any persons in any manner so as to become subject to the C USI S LICENSE M 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 3700 of the Labor Code,I shall If h ith-c ply ifhthose 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:VAILUT SEC JRE WORKER'S COMPENSATION COVERAGE 15 ❑Yes 0UNLAWFULA BIECT AN EMPLOYERTO CRIMINAL PENALTIES Will th mtended use of the building by the applicant or future building AND CIVIL F 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 guidell CONSTRUCTION LENDING AGENCY ❑Yes r" Z 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 bou dary of a school? (Section 3097 Civil Code) ❑Yes 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&Safety Code,Section 25505 and 25534 (ncerni g Contractor's License Law for the reason(s)indicated below by the hazar m t rial repo "age checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oY � ,\ Business and Professions Code).Any city or county that requires a permit to Date V construct,alter,improve,demolish or repair any structure,prior to its p RTY 0 NER AUTHORIZED AGENT issuance,also requires the applicant for the permit to file a signed statement that he or she is licensed pursuantto the provisions of the Contractor's State EPA EN V 0 EPAIR 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 orthrough 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 Contractor's State License Law does not apply to an owner of a o 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. p 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 Contractor's State License Law does not apply to an owner of a If your project does nit comply with EPA RRP rule please RII out the RRP Acknowledgement. BUILDING & SAFETY PERMIT/PLAN APPLICATION Menifee DATE: 5 too PERMIT/PLAN CHECK NUMBER — 090 TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPACID 9444enif 19 SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL ep O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES JUL DESCRIPTION OF WORK11 muce ive PROJECTADDRESS 2 �jt'WS d ZIP ASSESSOR'S PARCEL NUMBER 33j- +3Q- a�n LOT TRACT OWNERNAME ADDRESS 00 'Da1 PHONE EMAIL APPLICANT NAME ADDRESS Z sz- / PHONE O�% L� CZv �D EMAIL j . rOO I'i41 e,t IgoF ih tr.� CONTRACTOR'S NAME .= OWNER BUILDER? O YES BUSINESS NAME ADDRESS y t% PHONE 9O ' 2.3� .�D EMAIL �' S /�.r/l• /f7 CONTRACTOR'S STATE LIC NUMBER V'OQ 9'y-5— LICENSE CLASSIFICATION VALUATION$ SQ FT L SQ FT APPLICANT'S SIGNATURE DATE Cayr DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER D BUILDING PLANNING ENGINEERING FIRE ACCEPTE BY: PERMITFEE SMIP GREEN PLAN CHECK FEE INVOICETOTAL OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586951-672-6777 www.cityofmenifee.us