PMT16-00306 City of Menifee Permit No.: PMT16-00306
29714 HAUN RD.
�ACCELA7 MENIFEE,CA 92586 Type: Commercial New
MENIFEE Date Issued:
02/13/2017
PERMIT
Site Address: 28121 NEWPORT RD, MENIFEE, CA Parcel Number: 364-190-020
92584 Construction Cost: $469,311.00
Existing Use: Proposed Use:
Description of NCOM SHELL BUILDING WITH DRIVE-THRU 5,000 SQ FT
Work:
Owner Contractor
STATER BROS MARKETS T MORRISSEY CORPORATION
301 TIPPECANOE AVE 3740 OCEANIC WAY SUITE 301
SAN BERNADINO,CA 92408 OCEANSIDE, CA 92056
Applicant Phone: 7607226800
MENIFEE,CA License Number.708936
Fee Description ,gyt Amount t$)
Services, Switchboards,Control Centers&Panels 4 732.00
Services, Switchboards, Control Centers&Panels 1 283.00
Receptacle, Switch, Outlet&Fixture 26 241.00
Gas System 2 232.00
Plan Check Fee 103 102.50
Plan Check Fee 103 102.50
Plan Check Fee 103 102.50
Plan Check Fee 205 205.00
Sewer 1 150.00
Forced-Air or Gravity-Type Furnace or Burner 4 596.00
Air Handling/Condensing Units Non-SFR 4 732.00
Building Permit Issuance 1 27.00
Administrative Fee 74 74.18
Additional Plan Review Building 90 90.00
Additional Plan Review Building 2,165 2,165.24
GREEN FEE 1 18.00
SMIP COMMERCIAL 1 122.00
Performance Bond Deposit 52 52.25
New Construction Permit Fee 1 1,988.12
$8,015.29
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 slated,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_Pennit_Template.rpt Page 1 of 2
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑1 am exempt from licensure underthe Contractors5tate License Law for
Professions Code and my license is in full force and effect.Q / the following reason:
License Class A. L: License No. [d 17-13 By my signature below I acknowledge that except for my personal residence
Expires a 1 17 Signatur 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 DECLA have built as an owner-builder if it has not been constructed in its entirety by
o 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 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 ,w, ,leeinfo.ca.eov/calaw.Istml.
this permit is issued.
Policy# Date
o I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,forthe performance of the work forwhich ❑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 owner's behalf.I have read this
number are: - w�! ////�t application and the information 1 have provided is correct.I agree to comply
Carrier �I/YN/GIC/f/U CNrrGh �MSul4n Ce Lpvv7p(iny with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# GUL �/'��^ �f � Expires 611 /I� 7 enter the above identified property for inspection purposes.
(This section need not to be comnpTeted is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
1 shall not enrol ov any persons in any manner so as to become subject to the -e6 BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to theporker's compensation provisions of Section 3700 of the Labor
Code,I she ti comply with those provisions. Will the applicant or future building occupant handle hazardous material ora
� Applica Date 2 1 / mixture containing a hazardous material equal to orgreater thatthe
amounts specified on the Hazardous Materials Information Guide?
WARNIL E TO SECURE WORKER'S COMPENSATION[O RAGE IS o YesNUNLAWSHALL SUBIECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDREDTHOUSAND 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 forguidelines
CONSTRUCTION LENDING AGENCY ❑yes KNO
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 ANo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
1 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
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ekff No
Business and Professions Code).Any city or county that requires a permit to ilr..t Date_
construct,alter,improve,demolish or repair any structure,prior to its ROPE ER 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(RRPI
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 Ucense 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 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 Hill out the RRP
Acknowledgement.
BUILDING APPLICATION
Menifee c, ,� eA / a4
DATE 0 2104/20 1 6 PERMIT/PLAN CHECK NUMBER `Q
TYPE: [a COMMERCIAL ❑RESIDENTIAL MULTI-FAMILY ❑MOBILEHOME POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION []ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑✓ NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 5,000 SF miiti;eenant building shell w/drive-thru within anew shopping center desvelopment.
Tenant improvement drawings will be provided by offiejs under separate permit. Do
PROJECTADDRESS 78121 Newport:Road
ASSESSOR'S PARCEL NUMBER LOT TRACT
PROPERTY OWNER'S NAME Stater Bros Markets(Attn:Scott Limbacher)
ADDRESS 301 Tippecanoe Avenue,San Bernardino,CA 92408
PHONE EMAIL Scott.Limbacher@staterbros.com
APPLICANT NAME USS Slaton, LLC(Attn:Larry Canals) _
ADDRESS 5225 Canyon Crest Drive Suite 355, Riverside,CA 92567'
PHONE (951)760-0760 EMAIL fcent@aol.com
CONTRACTOR'S NAME OWNER BUILBER? [jYES2qNO
BUSINESS NAME -
ADDRESS • -
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLAS$[f1 TION
VALUATION$ $425,000.00 %4JA4)%`t4 FT 5,000 L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN is-
INVOICE b'�i1•
INVOICE ^^ PAID AMOUNT ��•�p O�H O CHECK M O CREDIT CARD VISA/MC
AMOUNT dN�•la
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# 0CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586951-672-6777
50 www.cityofinenifee.us Inspection Request Line 951-246-6213
3 ay �iv�