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PMT15-02231 City of Menifee Permit No.: PMT16-02231 29714 HAUN RD. 4ACCELA_�. MENIFEE, CA 92586 Type: Commercial New " MENIFEE Date Issued: 12129/2015 PERMIT Site Address: 30147 HAUN RD, MENIFEE, CA 92584 Parcel Number: 360-080-053 Construction Cost: $549,971.85 Existing Use: Proposed Use: Restaurant Description of NEW 2995 SQUARE FOOT EL POLLO LOCO RESTAURANT Work: Owner Contractor EL POLLO LOCO M D M CONSTRUCTION INC 3535 HARBOR BLVD#100 4212 E LOS ANGELES AVE#3421 COSTA MESA, CA 92626 SIMI VALLEY, CA 93063 Applicant Phone: 8055264174 ADN ARCHITECTS License Number: 629030 CA Fee Description Q11 Amount(SI Power Apparatus 6 900.00 Services, Switchboards, Control Centers&Panels 4 732.00 Services, Switchboards, Control Centers&Panels 1 283.00 Receptacle,Switch,Outlet&Fixture 196 1,091.00 Pole or Platform Mounted Fixtures 5 203.00 Plumbing Fixtures and Vents,fixtures 31 256.00 Grease Interceptor 1 116.00 Gas System 1 116.00 Water Heater 1 83.00 Plan Check Fee 103 102.50 Sewer 1 150.00 Forced-Air or Gravity-Type Furnace or Burner 2 298.00 Air Handling/Condensing Units Non-SFR 2 366.00 Hood Served by Mechanical Exhaust 4 876.00 Boilers, Compressors,and Absorption Systems 2 366.00 Building Permit Issuance 1 27.00 Additional Plan Review Building 525 525.00 Additional Plan Review Building 1,575 1,575.00 GREEN FEE 1 22.00 SMIP COMMERCIAL 1 154.00 New Construction Permit Fee 1 2,529.87 General Plan Maintenance Fee-Mechanical 1 95.30 General Plan Maintenance Fee-Plumbing 1 36.05 General Plan Maintenance Fee-Electrical 1 160.45 General Plan Maintenance Fee-New 1 126.49 Construction $11,189.66 AA_Bldg_Permit_Template.rpt Page 1 of 2 City Of Menifee LICENSED DECLARATION ❑ 1 am exempt from licensure under the Contractors'State License Law for the hereby affirm under penalty or perjury that I am licensed under provisions of following reason: Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that,except for my personal residence in Professions Code agdmy license is in full force and ejtecy,R,G 3 which I must have resided for at least one year prior to completion of License Class �� License do. (OG N improvements covered by this permit, I cannot legally sell a structure that I have Expired^l�o Signatu � - built as an owner-building it it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the WORKERS'COMPENSATI ON DECLARATION Business and Professions Code,is available upon request when this application is submitted or at the following Web site: ❑ I hereby affirm under penalty of perjury one of the following declarations: http://www.leainfo.ra.aovlralaw.html. I have and will maintain a certificate of consent of self-Insure for workers' compensation,issued by the Director of Industrial Relations as provided for by Date Section 3700 of the Labor Code, for the performance of work for which this permit is issued. Property Owner orAuthorized Agent Policy# ❑ By my Signature below, I certify to each of the following: I am the property l❑/ I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read this section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comply permit is issued.My workers'compensation insurance racier and policy number are: with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to enter the above- Carrie w,�,!- Ti�7' ,,y / identified property for the inspection purposes. Policy# 1710 y-7Z Expires ! l—�� Date Property Owner orAuthorized Agent (This section need not be completed if the permit is for City Business License# one-hundred dollars($100)or less) ❑ 1 certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION shall not employ any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a workers'compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the subject to the workers compensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide? Code,I shall forthwith comply with those provisions. p DYES ❑NO Appll��'�`flate; �� ! — �� WIII the intended use of the building by the applicant or future building occupant require a permit for the construction or modification from South WA ING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES ONO CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school? LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES ❑NO CONSTRUCTION LENDING AGENCY 1 have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of agency for the performance of the work which this permit is issued (Section California Health&Safety Code,Section 25505 and 25534 conceming 3097 Civil Code) hazardous material reporting. OWNER BUILDER DECLARATIONS DYES ❑NO I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT next to the applicable item(s)(Section 7031.5. Business and Professions Code: EPA RENOVATION.REPAIR AND PAINTING(RRPI Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors provisions of the Contractor's State License Law(Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978 Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firths and comply with she is exempt from Iicensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit: ❑ 1, as owner of the roe www.epa.gov/lead or contact the National Lead Information Center at property,rty, or my employees with wages as their sole 1-800-424-LEAD(5323). compensation,will do( )all of or( )porting of the work,and the structure is not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property ❑An EPA Lead-Safe Certified Renovator will be responsible for this project who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name: the building or improvement is sold within one year of completion,the Owner- Builder will have the burden of proving that it was not built or improved for the Firm Certification No.: purpose of sale). ❑ I, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Firm is required for this project because: contractors to construct the project(Section 7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who contracts for the projects with a licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement.