PMT15-03248 City of Menifee Permit No.: PMTIS-03248
29714 HAUN RD. Type: Commercial Alteration
<_ACCEL,P'�? MENIFEE, CA 92586
MENIFEE Date Issued: 04/20/2016
PERMIT
Site Address: 30067 HAUN RD, MENIFEE, CA 92584 Parcel Number:
Construction Cost: $192,692.50
Existing Use: Proposed Use:
Description of TENANT IMPROVEMENT"THE HABIT BURGER GRILL"2,500 SO FT INTERIOR WITH 525 SQ FT
Work: PATIO
Owner Contractor
RICH DEVELOPMENT JUNE A GROTHE CONSTRUCTION INC
600 N TUSTIN AVE, STE 150 15632 EL PRADO ROAD
SANTA ANA, CA 92705 CHINO, CA 91710
Applicant Phone:9099939393
MENIFEE, CA License Number: 671997
Fee Description ON Amount($1
Non-Residential Appliances, up to 1 HP 3 348.00
Services, Switchboards, Control Centers&Panels 4 732.00
Receptacle,Switch, Outlet&Fixture 128 751.00
Plumbing Fixtures and Vents,fixtures 2 116.00
Plumbing Fixtures and Vents,fixtures 22 211.00
Gas System 1 116.00
Water Heater 1 83.00
Sewer 1 150.00
Hood Served by Mechanical Exhaust 1 219.00
Boilers, Compressors,and Absorption Systems 2 366.00
Building Permit Issuance 1 27.00
Additional Plan Review Building 135 135.00
Additional Plan Review Building 735 735.00
GREEN FEE 1 8.00
SMIP COMMERCIAL 1 54.00
New Construction Permit Fee 1 886.39
General Plan Maintenance Fee-Mechanical 1 29.25
General Plan Maintenance Fee-Plumbing 1 33.80
General Plan Maintenance Fee-Electrical 1 91.55
General Plan Maintenance Fee-New 1 44.32
Construction
$6,136.31
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_Pe"it_Template.rpt Page 1 of 2
CITY OF MENIFEE
(xpires
s ICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
hapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law for
rofessions code and my license Is in full force and effect. the following reason:
icense Class—3 i is J 7/ '/ f / By my signature below 1 acknowledge that,except for my personal residence
Signature in which I must have resided for at least one year prior to completion of
improvements covered bythis 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 copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for worker's 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. www.leeinfo.ca.eov/calaw.htmL
Policy# :I--za I -Z 41 - we a 8Z S- Date
,?,I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,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 worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number are: 11 application and the information I have provided is correct.I agree to comply
Ul�Carrier 4u.�erf4o.-�i�InQl 11n-Cv TA InCr`_ with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#762 2-Ci/-W.48S_._Expires /7f 1311 2nl✓/D 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 of the work for which this permit is issued,
I shall not em I . any manner so as to become subject to the CITY BUSINESS LICENSE#
worker o nsatio laws of Ca I ia,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subj to the arkers ompensation ovisions of Section 3700 of the Labor
ode, sh o hwith amply it ose r " ns. Will the applicant or future building occupant handle hazardous material or a
pplican Date 5�-2.D-2VA mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide.
WARNING: ILURE TO SECUR WORKER'S COMPENSATION COVERAGE IS ❑Yes ,R'IVo
UNLAWFUL, ND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL F ES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION 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 v(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) ❑Yes A'No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the
Contractors License Law for the reason(s)indicated below by the hazardous
Healy Safety Cade,Section 25505 and 25534 concerning
hazardous a a rting.
checkmark(s)I have placed next to the applicable items)(Section 7031.5 Dyes >�
Business and Professions Code).Any city or county that requires a permit to Date yF - b
construct,alter,improve,demolish or repair any structure,prior to its ROPERTYO NEROR 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 RENOVA ON,REPAIR AND PAINTING IRRP)
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 exemptfrom 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 of the 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 notapply to an owner of a ❑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 improvementsare 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 provingthat it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑I,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.
kk1'�
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE 1 011 512 01 5 PERMIT/PLAN CHECK NUMBER ^
TYPE: ❑✓ COMMERCIAL []RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑✓ ELECTRICAL ❑✓ MECHANICAL
[]NEW ❑✓ PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Tenant finish out to anew shell space for a restaurant use(The Habit Burger Grill).Work is to
include architectural,mechanical,electrical,and plumbing. 2,500 s.f,interior.525 s.f. patio
PROJECTADDRESS 30067 Haun Rd.
ASSESSOR'S PARCEL NUMBER 360-080-053 LOT TRACT
PROPERTY OWNER'S NAME Rich Development Company
ADDRESS 600 N.Tustin Ave.,Suite 150,Santa Ana,CA 92705
PHONE (714)835-3311 EMAIL
APPLICANT NAME Matt Clark
ADDRESS 3500 S.Greenville St.,C-13,Santa Ana, CA 92704
PHONE (714)928-1166 EMAIL matt@clarkcd.com
CONTRACTOR'SNAME T.B.D. OWNERBUILDER? ❑YESZNO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ $300,000.00 kOka 'Fib FT 2,500 v
3Da3 LSQFi
APPLICANT'S SIGNATURE DATE 1 011 5/201 5
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE ?Q PAID AMOUNT y
AMOUNT .
;J 1 q J• OCASH OCHECKN 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECKN OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213