PMT16-03204 City of Menifee Permit No.: PMT16-03204
29714 HAUN RD. Type: Commercial Plumbing
'K��CCFEUA-r? MENIFEE, CA 92586
MENIFEE Date Issued: 10/13/2016
P E R M I T
Site Address: 28333 VALLEY BLVD, MENIFEE, CA Parcel Number: 339-030-021
92586 Construction Cost: $15,000.00
Existing Use: Proposed Use:
Description of ABANDON EXSITING GREASE TRAP, INSTALL NEW 1500 GALLON GREASE INTERCEPTOR
Work:
Owner Contractor
BROCKDALE SENIOR LIVING MURCO CORPORATION
6737 W WASHINGTON AVE#2300 5753 E SANTA ANA CANYON ROAD
CARLSBAD, CA 92018 SUITE G-150
Applicant Phone: 9492898473
KELLY HENRY License Number:974437
MURCO CORPORATION
5753 E SANTA ANA CANYON ROAD
SUITE G-150
ANAHEIM, CA 92807
Fee Description Qtv Amount
Grease Interceptor 1 116.00
Building Permit Issuance 1 27.00
Additional Plan Review Plumbing 74 74.18
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 5.80
$223.98
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 otherwiise 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
forlefted.
AA BidgPermit—Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of o I am exempt from licensure under the contmctoes State License Law for
Chapter9(commencing with section 7000)of Division 3 of the Business and
Professions Code and my license is in full force and effect. the following reason:
License Class —Lcense4ft It By my signature below I acknowledge that,except far my personal residence
Expires LE::;Si�gnature in which I must have resided for at least one year prior to completion of
-t-1 — improvements covered by this permit.I cannot legally sell a structure that I
IN
KER'S COMPE_ADECIA LATIO have built as an owner-builder if it has not been constructed initsentiretyby
�OR by ffir,u N er T 0 Ity of P P rJu N of ns I licensed contractors.I understand that a copy of the applicable law,Section
h re nd' peNa eriury one of the following cle lantions;I
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.leRinfo.ca.go-vLcalaw-htmI
this permit is issued.
Policy# —I G Doe) (PC) PROPERTY OWNER OR AUTHORIZED AGENT Date
o I have and will maintain worker's compensation insurance,as required by a By my signature below I certify to each of the following:I am the property
section 3700 of the Labor Code,for the performance of the work for which
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
application and the information I have provided is correct.I agree to comply
number are: with all applicable city and county ordinances and state laws relating to
Carrier tEA ISF76�6- Wt�znot'w building construction.I authorize representatives of this city or county to
Policy# Expires 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
o 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#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workier)compensation provi.sions of Section 3700 of the Labor Will the applicant or future building occupant handle hazardous material or a
Code,I shall f th omply with those provisions. mixture containing a hazardous material equal to or greater that the
Applic Date amounts specified on the Hazardous Materials Information Guide?
WARNING-FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 mYes cNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or futu re building
AND CIVIL FINES UP TO ONE HU N DRIED THOUSAND DOLLARS($100,000),IN occupant req uire a permit for the construction or modificatilon from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECrION 3706 OF THE LABOR CODE,INTERES-G AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY o Yes o 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) aYes allo
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 California Health&Safety Code,Section 25505 and 25S34 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ayes a 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 forthe permitto file a signed statement EPA RENOVATION,REPAIRAND PAINTING(RRP)
that he or she is licensed pursuant to the provisions of the Contractor's State
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 70313 by residence or childcare facility to be RRP-certified firms and comply with
a n 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
n 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.ena.goy/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800,424-LEAD(5373).
Code;The Contractor's State License Law does not apply to an owner of a n 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 yea r of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was n No EPA Lezid-Safe Certified Firm is required for this project because:
not built or improved for the purpose of sale.
ci 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 If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
."Wenifee
DATE PERMIT/PLAN CHECK NUMBER Fml o w4
TYPE: VOMMERCIAL 0 RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA SIGN
SUBTYPE: 0 ADDITION "�ALTERATION 11 DEMOLITION Q ELECTRICAL MECHANICAL
ONEW ��LUMBING 0 RE-RO I OF-NUMBER OF SQUARES
DESCRIPTION OF WORK AT-�&MC>ot,4 sx . Gve,�-� aP�� tt-3s;�u_ tqe'%AJ
Q ae44,6
PROJECTADDRESS YALA.E�( :t2jj 12 e,- LAk) oTy CA e)?-50'
ASSESSOR'S PARCEL NUMBER SSq-COL�'C)P-j LOT TRACT
OWNERNAME �_ivj tj(,a
ADDRESS \9
J�::Js6ao( ch -1)(DI
PHONE EMAIL
APPLICANTNAME Co6_�e.TFucnoo <�e�i Cx,--
ADDRESS /6_1(,A� C,&�Q YONS 2xil
PHONE EMAIL C-bM
CONTRACTOR'S NAME &.5 A��?FL4 cew� OWNER BUILDER? 0 YES t4O_
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALLIATION$ FT LSQFT
APPLICANT'S SIGNA70-ROd DATE 9 V9 I le
BUILDING PLANNING ENGINEERING FIRE GRE SMIP USINESS LICENSE NUMBER
DEPARTMENT DISTRIBUTION
INVOICE PAID AMOUNT
AMOUNT 0 CASH 0 CHECK# CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT
Q
CASH 0CHECK# CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
NBD-002
Office Copy REV. 04/2011
er i TI<T
2270 Trumble Road
P.O. Box 8300 City of Menifee
Perris, CA 92572-8300 Building & Safety Dept.
(951)928-3777 FIRST RELEASE
SEP 2 8 2016
Requesting Agency: City of Menifee
APPLICANT INFORMATION: Received
Business Name: BROOKDALE CHERRY HILLS
Site ID -Service Address: 1074992 - 28333 VALLEY BLVD, SUN CITY, CA 92586
Contact Name: JENNIFER BENNER
Contact Phone Number: (951) 526-8471 Fax Number:
Reguesting Anency&Applicant Please Note:
4 This "FIRST RELEASE" is being issued to allow applicant to pull permits with your agency and DDES-NOT
constitute a release for Certificate of Occupancy.
# A subsequent EMWD "CLEARANCE" or"FINAL RELEASE" is to be requested by applicant noted above and
will be submitted to your office prior to your agency issuing Certificate of Occupancy.
Your cooperation in this matter is greatly appreciated. It is extremely important that these procedures are followed for
EMWD to meet federal and state requirements.
Eastern Municipal Water District has reviewed and accepted the Application for Service and/or Waste Discharge
Application and plans dated 7/1/2016 and determined that the project is within EMWD service area(s).
EMWD to provide service. The provisions of service are contingent upon the applicant completing the necessary
arrangements in accordance with EMWD rules and regulations.
Fees Required:
New Business Fees Due. Call (951) 928-3777 extension 2081 for more information.
Source Control Fees Due. Call (951) 928-3777 extension 6203 for more information.
Inspection Required:
] Sewer Lateral. Call (951) 928-3777 extension 4838 or 4372 to schedule.
] Backflow Prevention. Call (951) 928-3777 extension 7906 to schedule.
] Rough Plumbing. Call (951) 928-3777 extension 6203 to schedule,
X] Interceptor Installation. Call (961) 928-3777 extension 6203 to schedule.
Interceptor Status:
No interceptor is required.
Current interceptor is acceptable. Size:
X] New interceptor to be installed. Size: 1500 gallon
IF THERE ARE ANY REQUIRED INSPECTIONS, Eastern Municipal Water District must inspect the service connection(s), instal ed
backflow prevention, and/or plumbing prior to backfilling to verify that the accepted plans have been followed and that
requirements have been met. Please make an appointment for inspection a minimum of 48 hours prior to backfilling to reduce
delays in construction. If you have any questions, please call EMWD at(951)928-3777 extension 6203.
Scarlett Draper-Source Control Plan Check 07/06/2016
EMWD Representative Date i I 00�-
Aru IP F 2270 Trumble Rd., Perris CA 92570
office Copy.0. Box 8300 Perris CA 92572-8300
Telephone (951) 928-3777
EASTERN MUNICIPAL WATER DISTRICT
PLAN CHECK SUPPLEMENTAL PAGE
Date: 09/14/2016 REF No.: SC2016000169
Business Name: BROOKDALE CHERRY HILLS
Site No. & Site Address: 1074992 - 28333 VALLEY BLVD, SUN CITY, CA 92586
1. Waste Discharge Application dated 7/1/2016 is acceptable for Source Control issues.
2. Installation of 1500 gallon grease interceptor and sample box is acceptable. The
interceptor must be installed per SB-70. See attached.
3. The rough plumbing must be inspected prior to backfilling. Installation of interceptor
including connections must be inspected prior to backfilling. Please call (951)
928-3777 ext. 6203 to schedule inspections 48 hours in advance. Failure to schedule
inspections may require dye test at an additional cost of $100.00 per hour.
4. If a water softener is installed currently or in the future, it must be of the type that does
not discharge brine to the sewer as per EMWD Ordinance 59.6 Article 3.6(A)(1):
"Prohibiting Users from discharging the regeneration cycle from any
water conditioning appliance, including but not limited to water softeners
or conditioners, to the POTW."
Inspector: Scarlett Draper Released for first to sd
For more information, please call EMWD Source Control Division at (951) 928-3777 ext
6203.