PMT15-02000 City of Menifee Permit No.: PMT15-02000
_ 29714 HAUN RD.
�CCELA— MENIFEE,CA 92586 Type: Commercial New
r°"'"`°"'a`"'" MENIFEE Date Issued: 10/04/2016
PERMIT
Site Address: 29737 ANTELOPE RD, MENIFEE, CA Parcel Number: 340-020-064
92584 Construction Cost: $5,210,560.00
Existing Use: Proposed Use:
Description of NEW GROUND-UP HEALTH AND FITNESS CLUB"LA FITNESS'38,106 SQ FT
Work:
Owner Contractor
FITNESS INTERNATIONAL SEPULVEDA COMMERCIAL DEVELOPMENT CORP
3161 EAST MICHELSON DR STE 600 2042 2ND STREET
IRVINE,CA 92612 NORCO,CA 92860-4101
Applicant Phone:9512799000
RKAA ARCHITECTS, INC License Number:780714
CA
Fee Description Qtz Amount lSl
Power Apparatus 1 183.00
Services,Switchboards, Control Centers&Panels 5 915.00
Services, Switchboards,Control Centers&Panels 3 849.00
Receptacle, Switch, Outlet&Fixture 349 1,856.00
Plumbing Fixtures and Vents,fixtures 86 531.00
Gas System 1 116.00
Plan Check Fee 103 102.50
Water Heater 2 166.00
Plan Check Fee 103 102.50
Sewer 1 150.00
Air Handling/Condensing Units Non-SFR 14 2,562.00
Building Permit Issuance 1 27.00
Additional Plan Review Building 7,800 7,800.00
Additional Plan Review Building 3,300 3,300.00
Additional Plan Review Building 5,250 5,250.00
Additional Plan Review Building 90 90.00
GREEN FEE 1 209.00
SMIP COMMERCIAL 1 1,459.00
Document Reproduction Reimbursement 76 76.14
New Construction Permit Fee 1 23,968.58
General Plan Maintenance Fee-Mechanical 1 128.10
General Plan Maintenance Fee-Plumbing 1 48.15
General Plan Maintenance Fee-Electrical 1 190.15
General Plan Maintenance Fee-New 1 1,198.43
Construction
$51,277.55
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 contractors)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that 1 am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and u I am exempt from licensure under the Contractors State License Law for
Professions Cade and my license is in full force and effect. the following reason:
License Class L—/O C-3!C License No. 7 7 j 1
By my signature below I acknowledge that,except for my personal residence
Expires 30 Signature in which I must have resided for at least one year priarto completion of
Improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATI N 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 workers 7044 of the Business and Professions Code,is available upon requestwhen
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.le¢info.ca.gov/calaw.htmL
this permit is issued.
Policy p Date
PROPERTY OWNER OR AUTHORIZED AGENT
pf"have and will maintain workers compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which �Qy 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
S j(4� P Fh Lz G� 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 g `/(rD *2- s7 I-ZO16 Expires I P7 enter the pboveideftified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred A 14 J V Date y 6
dollars($100)or less PRCtWY 6WNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
1 shall not emolov any persons in any manner was to become subject to the CITY BUSINESS LICENSE II
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 forthwitrm I ith those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant s ' // Date�a / L/(, mixture containing a hazardous material equal to or greater that the
PP r amounts specified on the Hazardous Materials Information Guide?
WARNING:F L TO SECURE WORKER'S COMPENSATION COVERAGE IS D Yes 00
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 PO
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) o Yes WNo
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
California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous material r orting.
checkmark(s)I have placed next to the applicable Ltem(s)(Section 7031.5 'es o No /
Business and Professions Code).Any city or county that requires a permit to Date td 5//b
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY O JE R AUTHOR17ED 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 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 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
o 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 o 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 bemuse:
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.
Y2
'u Menifee
DATE PEFM IT RAN CHECK NUM BER 15— 0
TYPE )QCOMMBFIAL ❑PESDBIMAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOtIS:IA ❑9GN
SUBTYPE ❑ADDITION ❑ALTBS4TION ❑DEMOUT10N ❑ELB:;RCAL ❑MECHANICAL
❑NBN ❑PLUMBING ❑9-5 ROOF NUMBEROFMUARES
DEKRFnONOFWOF;K CON4STRVC7-I0N OF A
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PR ECrADDRESS S E. G oQ HFQ N E w PORT `f' M EM/FE E
AS9B90RSPAFCaNUMBER 3G1f= !90- OSA- S— LOT TPACr
PR00Ef;rYOWNERSNAME 5T.47-rk (3 /20S M A 9 KETS
ADDREES 7-iPPEG.4NOE +QVE !;A-t-, SXkNA-ADIMo
PHONE EMAIL
AFF`UCANTNAME PQG ENlo (NO 49Q1146 GORY MAGC
ADDF13�; 160 s, SPRMIGS oAD
R-IONE71q G $S- 6 $6o EMAIL Gvnwck dre — en con,
CONTR4CTORSNAME T-Is D OWNBRBUILDER? ❑YES O
BUSNESS NAM E
ADDFEBS
R-ICNE EMAIL
CONTPACTORSSrATE UC NUMBER UCHds<QAMFlc4TICN
VALUATION$ > 21 O O O SD FT L SD FT
APRJCC/WTSSGNATUPE
DEPARTMENT DISrRBLMON OiYCF MENIFEE BUSNESSUO345=NUMBER
BUILDNG RANNING ENGNEERNG RI€ Camel 9v11P
INVOICE PAIDAMOUNT
AMOUNT ❑CASH ❑CiEOC# ❑O�ITCNO MSNMC
RAN CHECK FIRES PAIDAMOUNT ❑C44i ❑OiEGC# ❑ff;ITCARD MSNMC
ONNERBUILDBRVERRED DYES ❑ NO DLNUMBER NOTARZBDLErrER ❑ YES ❑ NO
City of Menifee Building& ,%fety Department 29714 Haun Fd. Menifee, CYO 92586 951-672-6777
www.cityofinenifee.usInspection Wquest Une951-246-6213
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