PMT18-04354 City of Menifee Permit No.: PMT18-04354
AF AM 29714 HAUN RD.
MENIFEE, CA 92586 Type: Sign-Permanent
MENIFEE MENIFEE Date Issued: 09104/2018
PERMIT
Site Address: 30015 WINTER HAWK RD, MENIFEE, CA Parcel Number: 360-020-072
Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of INSTALL 5 NEW ILLUMINATED SIGNS FOR TOMMYS CAR WASH-85 SO FT
Work: PLANNING APPROVED 08/29/2018
Owner Contractor
CAL CRUZ COMPASS SERVICES
LAKE ELSINORE, CA 92532 1245 N PARKER STREET#B
ORANGE, CA 92867
Applicant Phone:7142025711
COMPASS SERVICES License Number:943537
1245 N PARKER STREET#B
ORANGE, CA 92867
Phone:7142025711
Fee Description 41y1 Amount 1E1
Sign Permit 5 238.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 1.00
General Plan Maintenance Fee-Electrical 1 0.00
$267.00
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_Pennk_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 a 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 CIa C45j C)Lic se No. y; 57
By my signature below I acknowledge that,except for my personal residence
Expires Z'Z9,1c, Signature in which 1 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 ofthe following declarations:I licensed contractors.I understand that a copy ofthe 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 ofthe Labor Code,for the performance ofwork forwhich ,,vww.leeinfo.ca.eov/calaw.html.
this permit is issued.
Polity Date
61rhave and will maintain workers compensation insurance,as required by
PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Cade,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
Carrier 1p_'A Cr1z.X6 C' mplwy ap-W WE&I with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#USrff 567�190q Or: Expires �Z-�-/Y� enter the 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 ofthe work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the I CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become 1 1 HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 ofthe Labor
Code,I shallll f��grthwith comply with those provisions. /G Will the applicant or future building occupant handle hazardous material or a
a Applicant C� /7 >%N� Date 1�`'/ r(l / 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 ❑Yes e"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(SC construction
or See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES �'1 fo Coast
AirlQr}uea
CONSTRUCTION LENDING AGENCY 1 o Yes e(No
I hereby affirm that under the penalty of perjury there is a construction 1 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 1111`outer boundary of a school?
(Section 3097 Civil Code) Yes No
OWNER BUILDER DECLARATIONS )1I 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
Contractors License Law for the reasop(s)indicated below by the - California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the�applicable item(s)(Section 7031.5 - a hazardous mated- reporting. p ('
Business and Professions Code).Any city or county that requires a permit to iJ� 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 fRRPI
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 Cade)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 ofthe 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
property who,through employees'or personal effort,builds or improves the D An EPA Lead-Safe Certified Renovator will be responsible for this project
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:
a 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 Ifyour project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION � MENIFEE
DATE: 1 7"18 PERMIT/PLAN CHECK NUMBERTIM J
rlq
PLANNING CASE NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA VISIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK IaSTAGL E; I ftih Sf
PROJECTADDRESS 1-66-16 NSWPjtT 9-D. 1' +LF ZIP
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
ADDRESS Building Dept
PHONE EMAIL SEP Q 4 2018
APPLICANT NAME 5 IN1e
ADDRESS )zyS N ¢Ke UN (394#01E76 CA Received
PHONE _7 1L-(- ZC7Z-r7(( EMAIL (�Ovl
CONTRACTOR'S NAMEGtippsS 3EjijjGn5z OWNER BUILDER? O YES ONO
BUSINESS NAME -
ADDRESS /2.43�IJ. AftK f/ & -1e �c.ft
PHONE 71q'3GG^(5� nn
?' EMAIL l.kh'1 (F'iMP}$ Y ICIES-Caws
CONTRACTOR'S STATE LIC NUMBER V3;3r4 LICENSE CLASSIFICATION Clo C S Cho
VALUATION$ `1/JSO FT L SQ FT
APPLICANT'S SIGNATURE `� DATE 9-ti�l
CITYSTAFFUSEO
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL � GREEN SMIP '
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZEDLETTER O YES 0 NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofinenifee.us
NIF
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CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE 1169_ - _ -�.,�-�•M�crs.F:c,�i
y..-,.•.<-Cx<-c`z-e.-car,-n.-CrsSG�s�Cs�•�M6f',L`�`6.ede�=i.LK`�`-�'cC�iS- �s� -
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document.
State of California )
County of d9- suc P )
beforeme,
On c,fig te Here Insert Name and Title o the Officer
D�
personally appeared 0 B IF.,^,
Name(,$)-of SignerW
who proved to me on the basis of satisfactory evidence to be the person(o whose executed he same ie
subscribed to the within instrument and acknowledged to me that he/she/they
his/ber/then'authorized capacity(isO,and that by his/herlt-4eir signature(*on the instrument the person(s),
or the entity upon behalf of which the persons)acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
"'°"" WITNESS my h nd and official seal.
• DEBORAH PRISCO
COMM#2135377 a
NOTARY PUBUC-CALIFORNIA y
ORANGE COUNTY Signature
My Commission epifl!S �201 Signet u of Notary Public
Place Notary Seal Above OPTIONAL
on
Though this section
/fraudulent real reattaceting hment ofthis his for
m to/on can deter an unintendedldocu' f the document or
document.
Description of Attached Document tt
Title or Type of Document: ` Ycvn_ c� �'<:�n z (�" Document Date: tt�
Number of Pages: �_ Signer(s) Other Than Named Above: \IONS
Capacity(ies) Claimed by Signer(s)
_ . , n Q ;,,y S' ner's Name:
Signer's Name: �_ ❑Co ate Officer — Title(s):
❑Corporate Officer — Title(s):
❑Partner — ❑ Limited ❑General ❑ Partner — Limited ❑ eral
$Individual ❑Attorney in Fact
❑Individual ney in Fact
❑Trustee ❑Guardian or Conservator ❑❑ Othere Gua is or Conservator
❑Other: Si Signer I epresenting:
Signer Is Representing: u� — g
a�z=. . _
It m#5907
02014 National Notary Association www.NationalNotary.org - 1-800-US NOTARY(1-800-876-6B27) e
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