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PMT16-00081 City of Menifee Permit No.: PMT16-00081 29714 HAUN RD. Type: Commercial New <A-CCEL/? MENIFEE,CA 92586 MENIFEE Date Issued: 09/15/2016 PERMIT Site Address: 29061 NEWPORT RD, MENIFEE, CA Parcel Number: 364-190-020 92584 Construction Cost: $3,968,051.52 Existing Use: Proposed Use: Retail Description of CONSTRUCTION OF NEW STATER BROS SUPERMARKET BUILDING 45,586sf Work: MARKET 44,602sf, FOYER 660sf,&MEZZANINE 324sf Owner Contractor STATER BROS MARKETS STATER BROS DEVELOPMENT INC 301 S TIPPECANOE AVE P 0 BOX 150 SAN BERNARDINO, CA92408 SAN BERNARDINO, CA 92402 Applicant Phone: 9097335000 CHRIS BOYER License Number:444461 STATER BROS DEVELOPMENT INC P 0 BOX 150 SAN BERNARDINO,CA 92402 Fee Description ON Amount 1$) Services, Switchboards, Control Centers&Panels 13 2,379.00 Services, Switchboards, Control Centers&Panels 3 849.00 Receptacle,Switch,Outlet&Fixture 910 4,661.00 Plumbing Fixtures and Vents,fixtures 38 291.00 Grease Interceptor 1 116.00 Gas System 1 116.00 Plan Check Fee 103 102.50 Plan Check Fee 205 205.00 Water Heater 4 332.00 Sewer 1 150.00 Forced-Air or Gravity-Type Furnace or Burner 9 1,341.00 Air Handling/Condensing Units Non-SFR 3 549.00 Hood Served by Mechanical Exhaust 4 876.00 Building Permit Issuance 1 27.00 Additional Plan Review Building 9,609 9,608.58 Additional Plan Review Building 90 90.00 GREEN FEE 1 159.00 SMIP COMMERCIAL 1 1,112.00 New Construction Permit Fee 1 18,253.04 General Plan Maintenance Fee-Mechanical 1 138.30 General Plan Maintenance Fee-Plumbing 1 50.25 General Plan Maintenance Fee-Electrical 1 394.45 General Plan Maintenance Fee-New 1 912.65 Construction $42,712.77 AA_8ldg 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 cantractor(s)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 D I am exempt from licensure under the Contractors State License Law for Professions Code and my license is in full force and effect. t the following reason: License Class ( icense No. 1� 1 By my signature below I acknowledge that,except for my personal residence Expires 3 j7 Signatur o in which I 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 DECLARATI N have built as an owner-builder If it has not been constructed in Its entirety by D 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 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 www.leeinfo.ca.aov/calaw.html. this permit is issued. Policy# Date PROPERTY OWNER OR AUTHORIZED AGENT D I have and will maintain workers compensation insurance,as required by 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: f, � � application and the information I have provided is correct.I agree to comply Carrier �sx-.�C"C�vw Ft�%,� "� N� w with all applicable city and county ordinances and state laws relatingto r7 (� �1�� building construction.I authorize representatives of this city or county to Policy# �L-�1 S I I Q Ob Expires "l 3G� /-- enter the above identified property for inspection purposes. (This section need not to he completed is the permit is for one-hundred Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT D 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 o hwith comply with those provisions. p Will the applicant or future building occupant handle hazardous material or a Applicant \ Date I 5 j�P mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? ;:FA URE TO SEC ORKER'S COMPENSATION COVERAGE IS o 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($100,000),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 DNo 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) D Yes ❑No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the 5CAQMD 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 reasons)indicated below by the California Health al Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting. oyes D No Business and Professions Code).Any city or county that requires a permit to Date construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR 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 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 he 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 ❑1,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.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 Renovatorwill be responsible forthis 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 forthis project because: o 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.