PMT16-00516 City of Menifee Permit No.: PMT16-00516
29714 HAUN RD.
�CCEt_/> MENIFEE,CA 92586 Type: Commercial New
`"'"" W(A— MENIFEE Date Issued: 02/13/2017
PERMIT
site Address: 29101 NEWPORT RD, MENIFEE, CA Parcel Number: 364-190-020
92584 Construction cost: $746,508.00
Existing Use: Proposed Use:
Description of NCOM MULTI-TENANT SHELL BUILDING,8,400 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 Oft Amount
Services, Switchboards, Control Centers&Panels 2 366.00
Services, Switchboards, Control Centers&Panels 2 566.00
Receptacle,Switch, Outlet&Fixture 31 266.00
Grease Interceptor 3 348.00
Gas System 4 464.00
Plan Check Fee 205 205.00
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 1 149.00
Air Handling/Condensing Units Non-SFR 1 183.00
Building Permit Issuance 1 27.00
Administrative Fee 74 74.18
GREEN FEE 1 30.00
SMIP COMMERCIAL 1 210.00
Document Reproduction Reimbursement 52 52.25
New Construction Permit Fee 1 3,433.94
New Construction Plan Check 1 2,232.06
$9,166.43
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 building 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_Permit_Templatexpt Page 1 of
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe projects
with a licensed contractors)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. d �7 the following reason:
License Class A [7 ,G e License No. [QClgJ g m signature below I acknowledge that,exce t for m—)—T I y y g g p my personal residence
Expires 6 JaD 117 Signatur in which I must have resided for at least one year prior to completion of
improvements covered bythis permit.I cannot legallysell a structure that
WORKER'S COMPENSATION DECLA 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 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 WWW.Ieginfo.ca.gov/calaw.html.permit is issued.
Policy# Date
D 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 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:
- /�1 application and the information I have provided is correct.I agree to comply
Carrier /'1/Yj/.TZI/.�/✓f/U 2Jf�Ic� /MSG!({/1Ce (.OrM,OIj//c/ with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# M /qR-%//- !/36 - Expires 41Z IJ'7 enter the above identified property for inspection purposes.
oTS �
(This section need not to be camp eted is the permit iTs 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 emolov any persons in any manner so as to become subject to the IC6 BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the porkers compensation provisions of Section 3700 of the Labor
Code,1 Ocomply with those provisions. Will the applicant or future building occupant handle hazardous material or a
fmixture containing a hazardous material equal to or greater that the
Applica Date amounts specified on the Hazardous Materials Information Guide?
WARN[ SECURE WORKER'S COMPENSATION CO ERAGE IS o Yes )(No
UNLAWLL 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 r o ion occupant require a permit for the construct modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District SC ion or See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY o Yes cKNo
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 school?
(Section 3097 Civil Code) D Yes ANo
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
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.
q>(Qes No 1� � ��
Business and Professions Code).Any city or county that requires a permit to Date 1
"1�� 'y—
construct,alter,improve,demolish or repair any structure,prior to its <ROPEVKER 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(RRP)
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 Iicensure 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
D[,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 1-800424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a D 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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
D 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 role please fill out the RRP
Acknowledgement.
r
d=BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE 02/24/2016 PERMIT/PLAN CHECK NUMBER \Q-
TYPE: ❑✓ COMMERCIAL ❑RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION []ALTERATION ❑DEMOLITION []ELECTRICAL []MECHANICAL
❑✓ NEW ❑PLUMBING ❑RE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK 8,400 SF multi-tenant building shell within a new shopping center development.
Tenant improvement drawings will be provided by others under separate permit.
PROIECTADDRESS 29101 Newport Road
ASSESSOR'S PARCEL NUMBER 'jlALA-XRO - CQO 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 LISS Slaton, LLC(Attn:Larry Canals)
ADDRESS 5225 Canyon Crest Drive Suite 355, Riverside,CA 92507
PHONE (951)760-0760 EMAIL Ijcent@aol.com
CONTRACTOR'S NAME OWNERBUILDER? ❑YES[eNO
BUSINESS NAME
ADDRESS 127 OCCG ov
PHONE EMAIL e7• eo
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION sq
VALUATION $ $+-147900199 jgLR 5 '�`Q FT 8,400 L SQ FT Ss
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 30 SMIP o71O
INVOICE ry PAIDAMOUNT
AMOUNT Q �1 3 WA OCASH OCHECKA OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECKN 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 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 9S1-246-6213