PMT18-04154 City of Menifee Permit No.: PMT18-04154
29714 HAUN RD. Type: Commercial Alteration
�AF MENIFEE,CA 92586
MENIFEE MENIFEE Date Issued: 09/2012018
PERMIT
Site Address: 27190 SUN CITY BLVD, MENIFEE, CA Parcel Number: 337-310-035
92586 Construction Cost: $24,336.00
Existing Use: Office Proposed Use: Office
Description of INTERIOR ALTERATION ONLY TO EXISTING BUILDING 10,400 SQ. FT. FOR FUTURE TI
Work:
Owner Contractor
RANCHO INVESTMENT PARTNERS-SUN CITY, LLC J G STOUSE CONSTRUCTORS INC
28780 SINGLE OAK DR 24630 WASHINGTON AVENUE
TEMECULA, CA 92590 SUITE 102
Applicant Phone:9516969354
LISA MANKA License Number:687716
J G STOUSE CONSTRUCTORS INC
24630 WASHINGTON AVENUE
SUITE 102
MURRIETA, CA 92562
Fee Description Oty Amount 1$1
Building Permit Issuance 1 27.00
Additional Plan Review Building 129 129.07
Additional Plan Review Building 240 240.00
GREEN FEE 1 1.00
SMIP COMMERCIAL 1 7.00
New Construction Permit Fee 1 111.95
General Plan Maintenance Fee-New 1 5.60
Construction
$521.62
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 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 perjurythat 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 Contractors State License Law for
Professions Code and my license is in full farce and effect. the following reason:
License Crla's �—U nse No. f�f � By my signature below I acknowledge that,except for my personal residence
Expires "1 Signature "l.J 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 OECLARA N 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 Code,for the performance of work for which www.leginfo.ca.gov/calaw.html.permit is issued.
Policy# Date
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: L / p application and the information I have provided is correct.I agree to comply
nc�, with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
Polity# blot cpires, enterthe above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
Date
dollars($100)or less
PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
I shall not emoloy any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
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 f rthwith ca ly with t ose provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greaterthat the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑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 ❑Yes ❑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 ❑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 underthe State of
California Health al 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 item(s)(Section 7031.5
Dyes ❑No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,priorto 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
❑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. ❑No EPA Lead-Safe Certified Firm is required forthis project because:
❑1,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 outthe RRP
Acknowledgement.
BUILDING.&.SAFETY PERMIT/PLAN.CHECK_APP.LICATIONMENIFEE
AL. y;
DATE: PERMIT/PLAN CHECK NUMBER S
GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: Q COMMERCIAL 0 RESIDENTIAL O MULTI-FAMILY ® MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: frADDITION ()ALTERATION *DEMOLITION Q ELECTRICAL 0 MECHANICAL
C)NEW OPLUMBING ORE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK fl
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OCCUPANCYGROUP - CONSTRUCTION TYPE SPRINKLERSOYES ONO
PROJECT ADDRESS C7�JU�. ZIP C1202) ( In
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME '' /J — r'v 0 C
ADDRESS 7 CA 'A q26
PHONE jQgNs EMAIL
APPLICANTNAME
ADDRESS O CC 6I 7,
PHONE q5) EMAIL •,
CONTRACrOR'SNAME OWNERBUILDER? 0YES4NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER U0771 (p LICENSE CLASSIFICATION ED
TXWIp
VALUATION $ SQFT JoLL40(', ' LSQFT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: �y�q � CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE �(//�Y/
INVOICE TOTAL r-5a 1�3s I
GREEN _ SMIP
OWNER BUILDER VERIFIED 0 YES O NO DRIVERS LICENSE# NOTARIZED LETTER 0 YES O NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofmenifee.us
ENIF�
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