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HomeMy WebLinkAbout024957 SARA'S CAFE i Administrative Services-Licensing ' OFFICE USE ONLY -- 1' o� , 130 South Main Street LICENSE NO: Lake Elsinore,CA 92530 LAKE LS I NOKE. BUSINESS ID NO: —� PH 951.674.3124 x 302 1�Rrn�, E,Xrnt,.�u FAX 951.471.0052 CONTACT ID NO: to ww lake-elsinore.ora BUSINESS LICENSE APPLICATION-COMMERCIAL (Business Compliance Application must be approved prior to the issuance of your license) ;BUSINESS NAME: P` ;5 C BUSINESS PHONE: CORPORATE NAME(Ifap livable) BUSINESS START DOE: LOCATION ADDRESS: ' ,T35 PAM_WLu I ZIP: EMAIL ADDRESS: .. . ` BUSINESS DESCMP N: VCsa MAILING ADDRESS IF DIFFERENT THAN ABOVE ADDRESS CITY v STATE C>Ll ZIP: C ' CORPORATION (ijSOLE PROPRIETOR ( j PARTNERSHIP TRUST NON-PROFIT (] CORP-LTD LIABILITY (- ) OTHER BUSINESS INFORMATION XI D: OR EIN# ' SELLERS PERMIT# L 6 Q STATE CONTRACTORS LICENSE: ._ TYPE: _ EXP. PLEBE ATTACH.COPIES OFTHE FOLLOWING IF APPLICABLE: FICTI'CIOUSNAAt1EESTATEMENT IRSELLERS PERMIT/RESALE NUMBER L' HEALTH PERMIT [ABC LICENSE ❑ TOBACCO LICENSE ❑`BUREAU OF AUTO REPAIR ❑ COSMETOLOGY LICENSE CAMTC LICENSE ❑ OTHER: _ OWNER 1 NAME: �� t1YZ i vV OWNER 1 NAME: jt;} HOME ADDRESS: CITY,STATE,ZIP PHONE: � "State Mandated Disability Access Fee(SB 1186-$4.00 fee effective 1-01-18) Under federal and state law,compliance with disability access laws is a serious and significant responsibility that applies to all California building owners and tenants with buildings open to the public You may obtain information about your legal obligations and how to comply with disability access laws at the following agencies:The Division of State Architect at yYSywttlgtaao rldsalNomeasox;The Department of Rehabilitation at wwwrehab:cahwncf:uoy:and The California Commission on Disability Access aty4 w;ndaaa a 0- LICENSE FEE SCHEQUtE I declare under penalty of perjury that the statements made in thisapplication are true.I acknowledge and GENERAL- $72.00 YEAR understand that the Business License Certificate issued by the City of Lake Elsinore is a receipt evidencing PROFESSIONAL- $94.00YEAR that I have paldtheCitycif LakeElsinore Business Li(enseTax imposed underSection 5.08 of the Lake Elsinore CONTRACTORS- A&B$108.00 YEAR Municipal Code for the period indicated. Issuance of the certificate does not entitle me to carry on the C&D$ 6S.00YEAR business without complying with all other City building andzoning ordinances and aIIotherapplicablelaws. LICENSE FEES DUE O Licensefee "State CASp fee $4.00 Applicant Signature/Date , Emplo ees over 5 x$6.50 ea License Approval/Date G Units over 3 x$6.50 ea l j Total Due !, PETER ALDANA COUNTY OF RIVERSIDE Mail To:P.O.Box 751,Riverside,CA 92502-0751--(951)486-7000 ASSESSOR-COUNTY CLERK-RECORDER Ae F '"AN-0 OFFICE OF THE COUNTY CLERK FICTITIOUS BUSINESS NAME STATEMENT COUNTY CLERK'S FILING STAMP SEE REVERSE SIDE FOR FEES AND INSTRUCTIONS F I L E D CLERK'S USE ONLY County of Riverside -USE BLACK INK ONLY- Peter AldanaAssessor-Count Clerk-Recorder MUST BE TYPED OR PRINTED S 019-357162 Y INITIAL CROSS OUTS Fee R«ipf R-201914809 NO WHITE OUT ALLOWED Canancat,: _ 11/06/2019 12:07 PM Fee:$66.00 --------------------- Page 1 of 1 THE FOLLOWING PERSON(S)IS(ARE)DOING BUSINESS AS: Ia.Fictitious Business Name(If more than one business name at smra address-Attach Supplemental Sheet) SARA'S CAFE lb.List COMPLETE Physical Business Address(No P.O.Boxes or Postal Facilities) Ic.Name of County(where business is located) 31735 RIVERSIDE DR UNIT G&H,LAKE ELSINORE,CA 92530 RIVERSIDE Mailing Address(If different than business address—optional) 2a.Registrant Information(Individual,Corp.,LLC,Gen.Partner,etc.) 2b.Registrant Information(Individual,Corp.,LLC,Gen.Partner,etc.) GERARDO—MARTINEZ PENA Residence Address(if Corp.or LLC enter the physical address of the Corp./LLC) Residence Address(if Corp.or LLC enter the physical address of the CorpJLLC) CORONA CA 92879 City State Zip City State Zip List State of Corp./LLC.Must be registered in California List State of Corp./LLC.Must be registered in California 2c.Registrant Information(Individual,Corp.,LLC,Gen.Partner,etc.) 2d.Registrant Information(Individual,Corp.,LLC,Gen.Partner,etc.) if individual-spell out first,middle and last names(use dash if no middle name) If individual-spell out first,middle and last names(use dash if no middle name) Residence Address(if Corp.or LLC enter the physical address of the Corp./LLC) Residence Address(if Corp.or LLC enter the physical address of the Corp.;LLC) City State Zip City State Zip List State of Corp./LLC.Must be registered in California List State of Corp./LLC.Must be registered in California 3.This business is conducted by: (If More Than four Registrants-Attach Additional Sheet Showing Owner Information) ® Individual ❑Married Couple ❑Trust ❑Corporation ❑General Partnership ❑ A Limited Partnership ❑Co-partners ❑Joint Venture ❑Limited Liability Company ❑Limited Liability Partnership ❑ An Unincornorated Association-other than a partnership ❑State or Local Registered Domestic Partnership 4.® Registrant has not yet begun to transact business under the fictitious name(s)listed above. ❑ Registrant commenced to transact business under the fictitious business name(s)listed above on -- I declare that all the Information in this statement is true and correct. (A registrant who declares as true any material matter pursuant to Section 17913 of the Business and Professions Code that the registrant knows to be false is guilty of a misdemeanor punishable by a fine not to exceed one thousand dollars($1,000).) 5. Signature(s) (Only one is required) Typed or Printed Name(s)GERARDO—MARTINEZ PENA a II If Limited Liability Company/Corporation,Title QC'D BY: f` ` THIS STATEMENT WAS-FJLED WITH THE COUNTY CLERK OF RIVERSIDE COUNTY ON DATE INDICATED BY FILE STAMP ABOVE NOTICE-IN ACCORDANCE WITH SUBDIVISION(a)OF SECTION 17920,A FICTITIOUS BUSINESS I HEREBY CERTIFY THAT THIS COPY IS A CORRECT COPY NAME STATEMENT GENERALLY EXPIRES AT THE END OF FIVE YEARS FROM THE DATE ON OF THE ORIGINAL STATEMENT ON FILE IN MY OFFICE. WHICH IT WAS FILED IN THE OFFICE OF THE COUNTY CLERK, EXCEPT, AS PROVIDED IN SUBDIVISION(b)OF SECTION 17920,WHERE IT EXPIRES 40 DAYS AFTER ANY CHANGE IN THE PETER ALDANA FACTS SET FORTH IN THIS STATEMENT PURSUANT TO SECTION 17913 OTHER THAN A CHANGE IN THE RESIDENCE ADDRESS OF A REGISTERED OWNER. A NEW FICTITIOUS RIVERSIDE COUNTY CLERK BUSINESS NAME STATEMENT MUST BE FILED BEFORE THE EXPIRATION.THE FILING OF THIS STATEMENT DOES NOT OF ITSELF AUTHORIZE THE USE IN THIS STATE OF A FICTITIOUS /�� 1� BUSINESS NAME IN VIOLATION OF THE RIGHTS OF ANOTHER FEDERAL,STATE OR COMMON By\ 1-" Deputy LAW(SEE SECTION 14411 ET SEC.,BUSINESS AND PROFESSIONAL CODE). ACR 500(Rey.09/21,19) Avaltab:e in Alternate Formats Page 1 of 4 DISPLAY CONSPICUOUSLY AT PLACE OF BUSINESS FOR WHICH ISSUED CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION SELLER'S PERMIT 4 yE•l or�hP� November 16, 2019 ;l ACCOUNT NUMBER % 260843648-00001FopM. Office of Control: SARA'S CAFE Riverside Office GERARDO MARTINEZ PENA NOTICE TOPERMITTEE: 31735 RIVERSIDE DR UNIT G & H You are required to obey a Federal and State laws thatt LAKE ELSINORE CA 92530 regulate or control your business. This permit does not allow you to do otherwise. IS HEREBY AUTHORIZED PURSUANT TO SALES AND USE TAX LAW TO ENGAGE IN THE BUSINESS OF SELLING TANGIBLE PERSONAL PROPERTY AT THE ABOVE LOCATION.THIS PERMIT IS VALID ONLY AT THE ABOVE ADDRESS. THIS PERMIT IS VALID UNTIL REVOKED OR CANCELED AND IS NOT TRANSFERABLE.IF YOU SELL YOUR BUSINESS OR DROP OUT OF A PARTNERSHIP,NOTIFY US OR YOU COULD BE RESPONSIBLE FOR SALES AND USE TAXES OWED BY THE NEW OPERATOR OF THE BUSINESS. Not valid at any other address For general tax questions,please call our Customer Service Center at 1-800400-7115(TTY:711). For information on your rights,contact the Taxpayers'Rights Advocate Office at 1-888-324-2798 or 1-916-324-2798. CDTFA-442-R REV.18(5-18) A MESSAGE TO OUR NEW PERMIT HOLDER As a seller,you have rights and responsibilities under the Sales and Use Tax Law. In order to assist you in your endeavor and to better understand the law,we offer the following sources of help: • Visiting our website at www.cdfa.ca.gov • Visiting an office • Attending a Basic Sales and Use Tax Law class offered at one of our offices • Sending your questions in writing to any one of our offices • Calling our toll-free Customer Service Center at 1-800-400-7115(TTY:711) As a seller,you have the right to issue resale certificates for merchandise that you intend to resell.You also have the responsibility of not misusing resale certificates.While the sales tax is imposed upon the retailer, • You have the right to seek reimbursement of the tax from your customer You are responsible for filing and paying your sales and use tax returns timely • You have the right to be treated in a fair and equitable manner by the employees of the California Department of Tax and Fee Administration(CDTFA) You are responsible for following the regulations set forth by the CDTFA As a seller,you are expected to maintain the normal books and records of a prudent businessperson.You are required to maintain these books and records for no less than four years,and make them available for inspection by a CDTFA representative when requested.You are also required to know and charge the correct sales or use tax rate,including any local and district taxes.The tax rate applicable to your sales or use may not necessarily correspond to the tax rate of your business address displayed on this permit.You are also expected to notify us if you are buying, selling,adding a location,or discontinuing your business,adding or dropping a partner,officer,or member,or when you are moving any or all of your business locations. If it becomes necessary to surrender this permit,you should only do so by mailing it to a CDTFA office,or giving it to a CDTFA representative. If you would like to know more about your rights as a taxpayer,or if you are unable to resolve an issue with CDTFA,please contact the Taxpayers' Rights Advocate Office for help by calling toll-free, 1-888-324-2798 or 1-916-324-2798.Their fax number is 1-916-323-3319. Please post this permit at the address for which it was issued and at a location visible to your customers. California Department of Tax and Fee Administration Business Tax and Fee Division BILLING CONTACT GERARDO MARTINEZ LAKEii LS1i OKE SARA'S CAFE 31735 Riverside Dr, G/H Lake Elsinore,92530 INVOICE NUMBER INVOICE DATE INVOICE DUE DATE INVOICE STATUS INVOICE DESCRIPTION INV-00022755 02/26/2020 02/26/2020 DUE NONE REFERENCE NUMBER FEE NAME TOTAL BLDG-2020-00314 INSPECTION PROCESS FEE $73.00 OCCUPANCY PERMIT $30.00 PROFESSIONAL DEVELOPMENT FEE-OCCUPANCY $5.00 31735 Riverside Dr G/H Lake Elsinore, CA 92530 SUB TOTAL $108.00 TOTAL �— $108.00 "r I rn n 11 m-" 73 71.1 rr7 -, -- -: ,-, fl i'l T> ,.-, -•� - t m .- r-, m 71 -11 H11 ,� c7, M t-a h_% C4 ---------- ------------ ---------------- ^ nI - :- :-, -.J it rrI 1 2:. m m i ri k.n 11 M _'FIT:i k331 {J&4 1 - ` ,, I— ---------------------------- It :11d -.f_I F 4 k'_I.1.1 J �J i I I -i ,`i i-, f', I I i Y•. .Tl m Z7311;il Hb '=:7� +;�3�Ie `' p?�d t 1 -, a r•.. t r`n n t I ._:1 r.1 n r•_� Lb __ Si_Iti#7-'llE T-litijj t 1 ,7-- 11 - 7-1 '3'1L i M'k I-i F -1 LC' _ JJJ .�•_1.1-]S!1—i!'-�i.i 11 h•- 1 1! »L Zi-t[li_,-a•._t. _. - 313 33t-13 T r-t33t``'t[ f ..S- _ It I II t1 Q tt February 26,2020 ;C,_1- Iva 033, 4-IH;_i1 Page 1 of 1 i c"' O1 NON-CONSTRUCTION CERTIFICATE OF OCCUPANCY LA KE,�LS I�O1� For use.with"Commercial/Retail/Industrial"business locations within the city limits. Darn:�t ;jl'iirn;r. Inspection/Process Fee S73.00 due after Planning Approval $35.00 Occupancy Permit Required from Building Division f This form must be completed by the Business Owner or Representative and approved by Planning,Building and Fire divisions prior to the issuance of your business license. Business Name Phone r e Number __— ---�� � Business Add DQ, U-#"( l.{- Suite/Unit No.; $.q Footage:. Business Owner f Phone Number �� -d �J _7� - ^_ 4t.val.dy1tZ��acC� � Z' - Type of Business - AIX K O' Days&Hours of Operation -,I q. t Property Owner 14,Phone Number . Property Owner Addres City,State,Zip t� i complete description of business and operations: ,wv 7 7 New Business Ownership Change r_ Relocation ❑:. Other' i PLANNING DIVISION Please read and submit documents as required. Lease Agreement-If you are not the property owner,provide a copy of your lease agreement.Please be advised that the business owner should also the lease holder. i ( F e Plan-Show proposed layout of business,including areas devoted to offices,sales,storage manufacturing,seating,rest rooms and other uses. Plot Plart-Planner will.provide plot plan at time ofsubmittal. I All new signs and changes of signs require a separate permit. FIRE DIVISION Completed Fire Services check list.You are required to have a Knox Box. BUILDING DIVISION Does business involve conversion of existing building to new use? ❑ Yes ❑ No Do business operations involve use or storage of hazardous or toxic materials? ❑ Yes ❑No Does business involve any outside storage,work outside the building or off-site storage? ❑ Yes [] No All changes or additions to electrical,plumbing mechanical,or structural elements require a building permit.This includes partitions over 5'9"in height and new doorways or openings.Two sets of plans shall be submitted to the Building Division and appropriate permits obtained prior to any work being done. Prior to occupying a building or unit an Occupancy Inspection is required from the Building Division. An inspection fee must be paid along with the submittal of this form.Someone mustbe on premises at the time of inspection. Affidavit: I hereby certify that I have read and understood information furnished is accurate true,and correct. Applicant Signature/Date OFFICE USE ONLY APN No.311 " t Zone C-( Building Approval Date Planning Approval— � � ate-IL��/ZA:PZO Fire Approval Date Comments;�� Engineering Approval Date OCCUPANCY PERMIT REQUIRED CUP Required Yes Permit# Joanne Jackson From: Ronnie Morales Sent: Thursday, February 27, 2020 8:29 AM To: Joanne Jackson;Andrew Zavala; Scott Burns; David Burdick; Dale Heglund Cc: Ronnie Morales Subject: 31735 Riverside Drive, Suite G/H -Sara's Cafe - 20-00315 On 02/26/2020, Sara's Cafe has been granted fire clearance. 1 Clrr of Fire Business License Review Y� ' LAIC-E LSI NONE 130 S. Main St. a Lake Elsinore,California 92530 DREAM E)(7REMF (951)674-3124•Fax(951)471-1491 mlorales(alake-elslnare.ora Please print,type or complete on line Business Name � �AIS CAfC Fire Sprinklers Installed 2(yes ❑No I Check all applicable items(modlficationlinstaltatlon): 0"No modifications or installations have been performed i ❑Battery systems ❑Compressed gas ❑Fire doors/walls ❑Flammable and combustible liquid j ❑ Hazardous materials ❑industrial oven ❑LP gas installation or ❑Spray room,dip tank modification or booth ❑Standpipe system: ❑Temporary membrane ❑Wood products ❑Upholstered Furniture Installation,modification structure,tent or canopy or removal' I j Check:aftappllcable operational'permit`hams(CFC Section 1061:. [�(No modifications or installations have been performed ❑Cellulose nitrate film ❑Combustible dust- ❑Compressed gases ❑Covered and open producing operations mall buildings ❑Cryogenic fluids El Cutting and welding ❑ Dry cleaning ❑Explosives ❑ Flammable and ❑Floor finishing ❑ Fruit and crop ❑Fumigation and combustible liquids ripening insecticidal fogging ❑ Hazardous materials ❑ High-piled storage ❑ Hot work operation ❑Industrial ovens ❑ LP-gas ❑Magnesium ❑Open flames and ❑Open flames and torches candles ❑Organic coatings ❑ Places of assembly ❑ Pyrotechnic special ❑Pyroxylin plastics effects material ❑Refrigeration ❑ Repair garages and ❑Spraying or dipping ❑Storage of scrap tires equipment motor fuel-dispensing and tire byproducts facilities Applicant's Signature Date nu)►_p, Title. OU,C)PkC - r TV �( �I ewe N"" p� 9 c� u .P" ` �0 31 � EXHIBIT "A" PREMISES BROOKSTONE LANDING SHOPPING CENTER 31735 Riverside Drive, Suite "I" Lake Elsinore, CA 92530 ±1,000 Square Feet (Dimensions below are approximates) LINCOLN STREET 6c alm"11111 p_ w a � w r"N a Z CA m N — y J Vn b 0 2 a w _ v J w U _ m Ac w v - W r W D �$ 6 Exhibit A-1 — Imtols A I R C R Sa ASSIGNMENT AND ASSUMPTION OF LEASE AND CONSENT OF LESSOR 1. ASSIGNMENT OF LEASE For valuable consideration,the receipt and adequacy of which are hereby acknowledged, Jose Salvador Nieves DBA House of Eggs ("ASSIGNOR")hereby assigns and transfers to Gerardo Martinez & Georgina Rios DBA Sara's Cafe ("ASSIGNEE")all of ASSIGNOR's right,title and interest in and to that certain Lease dated August 30, 2017 by and between ASSIGNOR and Brookstone Landing, Inc ,as Lessor,covering those certain Premises located at(street address,city,state,zip) 31735 Riverside Dr Suite G, Lake Elsinore CA 92530 and as is more particularly described in such Lease. This Assignment shall be effective: Februar V 25, 2020 Signatures to this Assignment accomplished by means of electronic signature or similar technology shall be legal and binding. In addition,ASSIGNOR hereby transfers to ASSIGNEE all of ASSIGNOR's interest in and to any security or other deposits pad to Lessor under the terms of such Lease. Dated: February 25, 2020 Jove Sal -dor Nieves DBA House of Eqcfs By: � Na rinted: p `� iGv C�! Title: �rY� By: Name Printed: Title: Assignor 2. ASSUMPTION OF LEASE Assignee acknowledges that it has inspected the Premises and reviewed the Lease and Assignee hereby accepts the foregoing Assignment and assumes and agrees to be bound by and perform all obligations of the Lessee pursuant to the Lease arising on or after the date of this Assignment and to abide by all of the terms,provisions, covenants and conditions of the Lease. Dated: Gerardo Martinez & Georgina Rios DBA Sara's Cafe By: Name Pr' ted: Title: c ' By: > Name Printed: Cv=n f .4� .1 ?—i cj Title: D L j V�D V Assignee 3. CONSENT TO ASSIGNMENT Lessor hereby consents to the foregoing Assignment and Assumption of the Lease. It is understood and agreed,however,that the foregoing consent is not a waiver of Lessor's right to consent to or impose restrictions upon any future assignment or subletting. In addition,this assignment does not release Assignor from liability for any of the obligations of the Lessee under the Lease. Dated: Brookstone Landing, Inc By: Name Printed: Clyde Brunner Title: President INITIALS INITIALS ©2017 AIR CRE. All Rights Reserved. Last Edited:2/25/2020 4:22 PM AACL-1.02,Revised 06-10-2019 Page 1 of 2 By: Name Printed: Title: Lessor ATTENTION:NO REPRESENTATION OR RECOMMENDATION IS MADE BY AIR CRE OR BY ANY REAL ESTATE BROKER ASTO THE LEGAL SUFFICIENCY,LEGAL EFFECT,OR TAX CONSEQUENCES OFTHIS ASSIGNMENT ORTHE TRANSACTION TO WHICH IT RELATES.THE PARTIES ARE URGED TO: 1. SEEK ADVICE OF COUNSELAS TO THE LEGAL AND TAX CONSEQUENCES OF THIS ASSIGNMENT. 2. RETAIN APPROPRIATE CONSULTANTS TO REVIEW AND INVESTIGATE THE CONDITION OF THE PREMISES. SAID INVESTIGATION SHOULD INCLUDE BUT NOT BE LIMITED TO:THE POSSIBLE PRESENCE OF HAZARDOUS SUBSTANCES,THE ZONING OF THE PROPERTY,THE STRUCTURAL INTEGRITY,THE CONDITION OF THE ROOF AND OPERATING SYSTEMS,AND THE SUITABILITY OF THE PREMISES FOR ASSIGNEE'S INTENDED USE. WARNING:IF THE SUBJECT PROPERTY IS LOCATED IN A STATE OTHER THAN CALIFORNIA,CERTAIN PROVISIONS OF THE ASSIGNMENT MAY NEED TO BE REVISED TO COMPLY WITH THE LAWS OF THE STATE IN WHICH THE PROPERTY IS LOCATED. AIR CRE " https://www.aircre.com ' 213-687-8777 ` contracts @ai rcretom NOTICE: No part of these works may be reproduced in any form without permission in writing. INITIALS INITIALS © 2017 AIR CRE. All Rights Reserved. Last Edited: 2/25/2020 4:22 PM AACL-1.02, Revised 06-10-2019 Page 2 of 2 WAM Riverside County Sheriff's Department Lake Elsinore Station i 333 Limited, Lake Elsinore, CA 92530 Telephone: 951-245-3300 FAX: 951-245-3311 Trespass Letter of Authority C 602 PC Date: i To: Chief of Police I am the owner or owner's agent in lawful possession of certain real property located in the; ❑ City of Wildomar �T City of Lake Elsinore ❑ County of Riverside Specify full name address(s). 4A( A i-> C ikF--F 3_( 7-S S t! l�Esi_a /)E- U►)>"r h f' fN ill1'tl CurP&P� PROPERTY NAMES STREET NUMBER(s)AND NAME(s) --r I have seen..an influx of undesirable trespassers in;:this neighborhood. Because,.of this trespassing, I have experienced monetary-loss due to vandalism, resulting in a decrease of paying;tenants. t am concerned about possible theft, drug dealing sndlor,drug usage caused:by trespassers on the property: t have posted all entrances on the property, in pram view with no trespassing signs as welt as-all carports and common areas associated With the property; I request` prosecution for anyone who is loitering at the-Property and/or is:°engaged in any unlawful activity. t expressty authorize your officers to.arrest and/or issue citations to trespassers during th6foll6wing.ane year,Wiled: rtingon:; (Date) -t�)Z Z G .2.0 -7 C) I understand it is my responsibility to renew s authorization in one year from the above date. I will notify you, if sometime in the future, I m no longer the own or agent of the property. i The following information provides your department with the ability t d ntact me or rsons with authority to respond in my absence. Owners Phone:.,: Manager/Requestev—`(—c 'V�)Eg!� 1 Print Full a1J mew 1 ture Address A.M. Phone P.M. Phone C= I T Y C3 1: �CW -I._, A.IKE L S I. IN C)TZE 12 D I F A M EX r i2 1- M 1: 130 South Main Street APPLICATION FOR APPL �TIg�lOyo. ^ PLLICATION RECEIVED I3iJI:LD`LNG PERMIT DATE AP P VALUATION CALCULATIONS tj 1ot FLOOR SF 1st° !):F 2nd FLOOR .SF 3rd FLOOR SF: O W GARAGE SF N .ADDRESS STORAGE SF R em y a..nn ,at.I orn1icons'60 Mclarprovisions of chapter (commencing j DECK&BALCONIES SF with section 7000)ot;.dlvlalon.3 of tho_tiuslnsss and professlons codn,and C Imy,1(reise fe In full force and.effact OTHER: SF O LICENSE# CITY BUSINESS N AND CLASS TAX# T VALUATIoN. R A MAILINU C ADDRESS FEES T CITY STATE/-LIP PHONE O { BUILDING PERMIT . R CON rRACTOR'SSIGNATURE PLAN CHECK NAME A i PLAN REVIEW R MAILINQ C ADDRESS SEISMIC H CITY 9TAME77115 PROM PLAN RETENTION O NEW. OCC GRP./ CONST. 0 4DDtTION, D(V16ION: TYPE, 1-3 ALTERATION NUMBER OF NUMBER OF 0 OTHER STORIES: BEDROOMS: C3.81INGLE.FAMILY ZONE. P APARTMENTS Q 1 certify that 1 have read this application and state that the 0.CONDOMINIUM HAZARD YES above Information Is correct.I agree to comply with all city O TOWN HOMES AREA 7 NO and county ordinances and stale laws relating to building 0 COMMERCIAL SPRINKLERS YES construction,and hereby authorize representatives of this 0 INDUSTRIAL REQUIRED 7 NO city to enter upon the above-mentioned property for Insp- CO REPAIR PROPOSED USE OF BLDG: tion purposes. 0 DEMOLISH PRESENT USE OF BLDG: JOB DESCRIPTION gnature of Appt ant or Agent Date Agent for p contractor 0 owner Agents Name ...._ Agents Address _ sp"�s Street City State Zip 1.1 am licensed under the provisions of Business and Professional Code Section 7000 at seq.and my license is in full force. 2. I, as owner of the property,or my employee w/wages as their sole compensation will do the work and the structure is not intended or offered for sale. 3.I,as owner of the property,am exclusively contracting with licensed contractors to construct the project. 4.1 have a certificate of consent to self-insure or a certificate of Workers Compensation Insurance or a certified copy thereof. S.1 shall not employ any person in any manner so as to become subject to Workers Compensation Laws in the performance of the work for which this permit is issued.