PMT15-01933 City of Menifee Permit No.: PMT15-01933
29714 HAUN RD.
471tCC UA-> MENIFEE,CA 92586 Type: Commercial New
MENIFEE Date Issued: 01103/2017
PERMIT
Site Address: 29971 ANTELOPE RD, MENIFEE, CA Parcel Number:
92584 Construction Cost: $977,488.29
Existing Use: Proposed Use: Service Station
Description of CONSTRUCTION OF NEW CHEVRON STATION AT MENIFEE LAKES PLAZA TO INCLUDE
Work: CARWASH, LUBE CENTER&CONVENIENCE STORE SEE PMT15-04036 FOR PC FEES FOR LUBE
CENTER
Owner Contractor
VINTNERS DISTRIBUTORS, LCC/MR NICK GOYAL PROGRESSIVE ARCHITECTURE&
41805 ALBRAE ST2ND FLOOR CONSTRUCTION INC
FREMONT, CA 94538 2440 RAILROAD STREET
Applicant Phone:7147771169
M I ARCHITECTS, INC License Number:671588
, CA
Fee Description Dot Amount ISI
Non-Residential Appliances, up to 1 HP 9 1,044.00
Power Apparatus 1 183.00
Services, Switchboards,Control Centers&Panels 7 1,281.00
Receptacle, Switch, Outlet&Fixture 182 1,021.00
Pole or Platform Mounted Fixtures 7 213.00
Plumbing Fixtures and Vents, fixtures 20 201.00
Grease Interceptor 3 348.00
Plan Check Fee 205 205.00
Plan Check Fee 103 102.50
Water Heater 1 83.00
Sewer 2 300.00
Forced-Air or Gravity-Type Furnace or Burner 2 298.00
Air Handling/Condensing Units Non-SFR 2 366.00
Building Permit Issuance 1 27.00
Administrative Fee 108 108.09
Additional Plan Review Building 1,785 1,785.00
GREEN FEE 1 40.00
SMIP COMMERCIAL 1 274.00
Document Reproduction Reimbursement 94 93.95
New Construction Permit Fee 1 4,496.45
New Construction Plan Check 1 2,922.69
General Plan Maintenance Fee-Mechanical 1 33.20
General Plan Maintenance Fee-Plumbing 1 46.60
General Plan Maintenance Fee-Electrical 1 187.10
General Plan Maintenance Fee-New 1 224.82
Construction
$15,884.40
AA_Bldg_Permit_Template.rpt Page 1 of 2
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
With a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of .
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. p the following reason:
License Class B License No. 5 a Op By mysignature below 1 acknowledge that,except for my personal residence
Expires '-36 20 IX Signature in which l 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 he following deci ations: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
this permit is issued. �i www.leeinfo.ca.eov/calaw.htmL
-'y G Policy# I'l 8q L o — Date
p0fhave 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 o 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:
4544�.- �-l�j,$09A,� EnAP-Vag 6 application and the information I have provided is correct.I agree to comply
Carrier VV �� with all applicable city and county ordinances and state laws relating to
/' Yn1 // building construction.I authorize representatives of this city or county to
Policy# �'�.��,.�� 837�� Expires d5/ if-7/20/7 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less Date
PROPERTY OWNER OR AUTHORIZED AGENT
o 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 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 forth ith comply w'Eh those provisions. / Will the applicant or future building occupant handle hazardous material or
Applicant Date �! mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:ALRE TO SECURE WORKER'S COMPENSATION COVE GE IS D Yes o 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($100,0(10),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OFF THE
HE LABOR
ABOR CODE,INTEREST,AND ATTORNEYS FEES forguldelines
CONSTRUCTION LENDING AGENCY ❑Yes n 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) u Yes o No
OWNER BUILDER DECLARATIONS I 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 reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable items)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to oYes n No
construct,alter,improve,demolish or repair any structure,prior to its Date
issuance,also requires the appficant for the perm it to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRPI
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 apre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare n for most
beork tcertffied firms and comply with
than
Applicant for a permit subjects the applicant to o civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424•LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a D An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project because:
01,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
City of Menifee PMT15-01933 n�
9/18/2015 �1C
[DO NOT PAY- THIS IS NOT AN INVOICE]
VALUATION AND PLAN CHECK FEE
JURISDICTION: City of Menifee PLAN CHECK NO.: PMT15-01933
PREPARED BY: David Yao DATE: 9/18/2015
BUILDING ADDRESS: Antelope & Newport Rd.
BUILDING OCCUPANCY: M/B/S1
BUILDING FATE-A-7 Valuation Reg. VALUE ($)
PORTION ( Sq. Ft.) Multiplier Mod.
store 3439
canopy 3870
carwash 1489
lube 2575
Air Conditioning
Fire Sprinklers
TOTAL VALUE
Jurisdiction Code mnf Manual Input
Bldg.Permit Fee by Ordinance
Plan Check Fee by Ordinance 1
Type of Review: ❑� Complete Review ❑ Structural Only
❑Repetitive Fee
❑ Other
--� Repeats D—ti� 1 17 Hrs. @
-J EsGil Fee $105.00 $1,785.00
Based on hourly rate
Comments:
Sheet 1 of 1
macvalue.doc+