PMT16-02832 City of Menifee Permit No.: PMT16-02832
< _6CE!U 29714 HAUN RD.
A A> MENIFEE, CA 92586 Type: Commercial New
0�11. A S141- MENIFEE Date Issued: 12127/2016
P E R M I T
SiteAddress: 25904 NEWPORT RD, MENIFEE, CA Parcel Number: 339-200-083
92584 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of RE-PLANET 496 SO FT CRV STATE CERTIFIED RECYCLING CENTER AT STATER BROS.
Work: GROCERYSTORE
Owner Contractor
REPLANET, LLC J B INSTALLATIONS
800 N HAVEN AVE#120 30190 SANTA CECILIA DR
MENIFEE, CA 91764 TEMECULA,CA 92592
Applicant Phone:9518181859
BRIAN JACKSON License Number: 908071
30191)SANTA CECILIA DR
TEMECULA, CA 92592
Phone:9515152705
Fee Description ON Amount($1
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
Additional Plan Review Building 129 129.07
Additional Plan Review Building 129 129.07
Additional Plan Review Building 129 129.07
Additional Plan Review Building 65 64.54
$607.82
The issuance of this permit shall not prevent the building officlial 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.
AkBld9_Perrnft_Template.rpt Page I of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or Improves thereon,and who conlracts 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).
Chapter5l(commencing with section 70130)of Division 3 of the%ineq and o I am exempt from licensure under the Contractor's State License Law for
Professions Code and my Iloqnse I.s in Tull foll the following reason:
License Clas t .cerise No. By my signature below I acknowledge that,except for my personal residence
) ? 'IrT�
ExpiresS, Signature in which I must have resided for at least one year prior to completion 0i
JJ,J r2o im r ements covered by this permit.I cannot legally sell a structure that I
WOR 11 OMPTINITION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
ct I hereby affirm under penalty of perjury one ofthe following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have a nd will ma Inta In a certificate of consent of self-insure for worker's 7044 of the Business and Professions Code,is available upon requ est when
com pensation,issued by the Director of Industrial Relations as p rovided 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.leginfe.ca.goy/calaw.litmi.
Policy# Date
o I have and will mainta in worker's compensation insure nce,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance ofthe work for which o By my signature below I certify to each ofthe following!I am the property
this permit is issued.My worker's compensation insurance career and policy owner or authorized to act on the property owner's behalf.I have read this
number are: application and the Information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Expires enter the above identified property for inspection purposes.
s'
(This section need notto be completed is the permit is for one-hundred
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT Date
I certify that in the performance of the work for which this permit is issued,
Ishallnotemplo any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws ofCallfornia,and agree that if]should become
subject to the worker's compens . rovisions of Section 3700 ofthe Labor HAZARDOUS MATERIAL DECLARATION
Code,I shall fc, ith y with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant DateL2 12 7 mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING2 ETOSEd6;iWORKER'SCOPAPFNSATIOdCOVEPdGEIS o Yes a No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use ofthe building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the:onstruction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management D Arict(SCAQMD)?See permitting checklist
for guidelines
CONSTRUCrION LENDING AGENCY ciYes oNo
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet ofthe
lending agency for the performance ofthe work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) oYes nNo
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 i.nderstand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25SOS and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material t*eporting.
Business and Professions Code).Any city or county that requires a permit to aYes o No
construct,after,improve,demolish or repair any structure,prior to Its Date
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions ofthe Contractoes State EPA RENOVATION,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 exempt from ficensure
and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint in a pre-1978
an Applica nt for a permit subjects the applica nt to a civil pena Ity,of not more residence or childcare facility to he RRP-certified firms and comply with
than($500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
o 1,as owner of the property,or my employee with wages as their sole empic-fees.For more information about EPA�s Renovation Program visit:
compensation,will do( )all of or I )portion of the work,and the structure is Wwv ePa.goy/fead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-8'1'0-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner ofa o�.n 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 ofproving 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:
o 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a I I you r p roject does not cc mply with EPA RRP ru le please fil I o ut th e RRP
Acknowledgement.