PMT18-03687 City of Menifee Permit No.: PMT18-03687
29714 HAUN RD.
�Ar MENIFEE,CA 92586 Type: Commercial Alteration
MENIFEE MENIFEE Date Issued: 07/25/2018
PERMIT
Site Address: 30024 HAUN RD 140, MENIFEE,CA Parcel Number: 360-690-026
92584 Construction Cost: $100.00
Existing Use: Proposed Use:
Description of HOURLY INSPECTION FOR CERTIFICATE OF OCCUPANCY FOR"EVERBOWL"
Work:
Owner Contractor
EVERBOWL, LLC ,
3132 TIGER RUN CT#108
CARLSBAD, CA 92010
Applicant License Number:
MENIFEE,CA
Phone:7605852043
Fee Description ON Amount fSl
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 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_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 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
❑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 Cade,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 ,,v,,,yv,le¢info.ca.aov/calaw.html.
this permit is issued.
Policy p 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 fallowing: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
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 q Expires a he a identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date Z) ^f J
dollars($300)or less PROPERTY O NER OR 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 p
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
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE 70 SECURE WORKER'S COMPENSATION COVERAGE IS a Yes p'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 madifcation from South
ADDITION 70 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 370fi OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY in Yes Xwo
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 KNo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exemptfrom the permitting checklist.I understand my requirements under the State of
California Health&Safety Code,Section 25505 and 25534 concerning
next Contractor's License Law for reason(s)indicated below by the haz ous material reporting.
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 11 Date ' 74
construct,alter,improve,demolish or repair any structure,prior to Its p OeERTY WI ER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement ` J
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRP)
Ucense 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
D 1,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(5323).
Code;The Contractor's 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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
o 1,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 not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
CERTIFICATE OF OCCUPANCY APPLICATION M EN I F EE
DATE 7 Z-S" PERMIT NUMBER
BUSINESS NAME Q_✓t r JC'Lu TYPE OF BUSINESS (A 12
ADDRESS `•C` 41 t{C'
NAME OF BUSINESS OWNER(5) ✓P r Lj I` (J-C/ r
ADDRESS(IF DIFFERENT FROM ABOVE) 3 3 `L (r (; n- `YL VY—� Cr I ( U
R-Cz LJ-43.", . CA- nj2C10 p n
PHONE -1 60"S?TC-Z-( 3 EMAIL e eve-v 10c••tiI C U
OWNER OF BUILDING D(-)yAC'L Lw-( C Ii4."C' /-"
ADDRESS E' j3<2ICz� S r� V, G U C G,S M Juk I L( r<w A
PHONE (( EMAIL
DESCRIBE EXACT USE OF BUILDING: '+ C
PREVIOUS USE OF BUILDING/SUITE
ACKNOWLEDGEMENTAPPLICANT
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, �'� or P- - t)'-/ hereby agree to comply with the above-described terms in this
Application for Certificate of Occupancy.
z 4) -
DATE - 2j ,
( f
APPLICANT
CITY STAFF USE ONLY D DATE IF APPROVED)
BUS LICENSE DATE HEALTH DEPT DATE
BUS LIC.NUMBER FIRE DATE
PLANNING DATE EM W D DATE
ENGINEERING DATE BUILDING DATE
ENGINEERING INSPECTION(INCLUDE VERIFICATION OF BMP's BUILT PER PLANS/WQMP)
REF WO,JSW# APPROVED BY DATE
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofmenifee.us
TENANT DISCLOSURE FORM - CERTIFICATE OF OCCUPANCY N I FEE
AV
DATE 'r7
BUSINESS NAME
BUSINESS ADDRESS
NAME(S)OF BUSINESS OWNERS IFE"!X) STEP—
PHONE NUMBER —76C' VL,"3EMAIL V. bT'L k- Cb�✓
OWNEROFBUILDING � � — ., •,�
OWNER OF BUILDING ADDRESS G (j Ste] I /'L CS C/� 2G 2 6
INTENDED BUSINESS USE Ck� �2
IS THIS A NEW BUSINESS IN THE CITY OF MENIFEE? YES NO (CIRCLE ONE)
ARE YOU THE FIRST TENANT TO OCCUPY THIS SPACE? YES 10 ) (CIRCLE ONE)
IS THE BUILDING EQUIPPED WITH FIRE SPRNKLERS? YES NO (CIRCLEONE)
SQUARE FOOTAGE 1 C UL] NUMBER OF EMPLOYEES
NUMBER AND LOCATION OF RESTROOM FACILITIES — p ,N : rCJC `r`-'
LISTANYTOXIC CHEMICALS, FLAMMABLE/COMBUSTIBLE LIQUIDS OR GASES USED OR STORED WITH
MSDS SHEETS AND ,771ES 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 ' 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 PE ITS
SIGNATURE DATE 2J`(
PRINTNAME K 9
TENANT / OWNER / CONTRACTOR / ARCHITECT / ENGINEER (CIRCLE ONE)
FOR CITY STAFF I PERMIT NUMBER
OCCUPANCY GRP TYPE OF CONST I STAFF INITIALS
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofmenifee.us
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