PMT16-03332 City of Menifee Permit No.: PMT16-03332
29714 HALIN RD. Type: Commercial Alteration
<A-CCELA—> MENIFEE,CA 92586
MENIFEE Date Issued: 06/15/2017
P E R M I T
Site Address: 29121 NEWPORT RD, Suite#101, Parcel Number: 364-190-020
MENIFEE, CA 92584 Construction Cost: $203,840.00
Existing Use: Proposed Use: Office
Description of TENANT IMPROVEMENT FOR PACIFIC DENTAL SERVICES,3200 SF
Work:
Owner Contractor
STATER BROS MARKET DONALDB WEBB
301 S TIPPECANOE AVE 5905 DICKENS AVE
SAN BERNADINO, CA 92408 RIVERSIDE,CA 92506
Applicant Phone:9496B95015
JAY FREYDER License Number.709664
DONALD B WEBB
5905 DICKENS AVE
RIVERSIDE,CA 92506
Fee Description aty Amount
Non-Residential Appliances, up to 1 H P 5 580.00
Receptacle, Switch,Outlet&Fixture 171 966.00
Plumbing Fixtures and Vents,fixtures 8 141.00
Sewer 1 150.00
Building Permit Issuance 1 27.00
Additional Plan Review Building 1,716 1,715.78
GREEN FEE 1 9.00
SMIP COMMERCIAL 1 58.00
New Construction Permit Fee 1 937.66
General Plan Maintenance Fee-Plumbing 1 14.55
General Plan Maintenance Fee-Electrical 1 77.30
General Plan Maintenance Fee-New 1 46.88
Construction
$4,723.17
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of emors in the plans and
specifications or from pnwenting 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 he
forfeited.
AkB1dg_Pe"it Template.rpt Page 1 of 1
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 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. the following reason:
LicenseClass— 1�) Ucense;40. By my signature below I acknowledge that,except for my personal residence
Expires 7 signature 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 structu re that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
wrh,reby affirm under pena Ity 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
this permit is issued. www.leginfici.ca.goy/calaw.libril.
Policy# C>-L Date
PROPERTY OWNER OR AUTHORIZED AGENT
o I have and will maintain workerjs compensa don 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 worker's compensation insurance cander and policy owner or authorized to act an the property owner's behalf.I have read this
number am: application and the information I have provided is correct.I agree to comply
Carrier Ave-k :Fui--3tAv�%0"-� r-b' with all applicable city and county ordinances a nd state laws relating to
building construction.I authorize representatives of this city or county to
Policy# lbc�-Z-STSS-7�Kl Expires -3 enter the a bove 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,
Ishallnotemplo any persons in any manner so as to become subject to the CITY BUSINESS LICENSE it
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwit ose provision VVIII the applicant or future building occupant handle hazardous material or a
Applicant_ mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ci Yes ci No
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 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 forguldefines
CONSTRUCTION LENDING AGENCY ri 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) ciYes ciNo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCACJNID
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 25534 concerning
Contractor's License Law for the reason(s)Indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the a pplicable Item(5)(Section 7031.5 oYes ci 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 lie or she Is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING[RRPl
Ucense 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 pena Ity 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
ci 1,as owner of the property,or my em ployee with wages as their sole employees.For more information about EPA!s Removatlion Program visit:
compensation,will do I )all of or I )portion of the work,and the structure is www.epa.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(5323).
Code;The Contractor's State License Law does not apply to an owner of a cp An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'ar 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 nne 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. in No EPA Lead-Safe Certified Firm is required for this project because:
a 1,as owner of the property a in exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State Umnse 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
'�'i-;"Menifee
DATE J0 IhIlLf PERMIT/PLAN CHECK NUMBER
TYPE: ZCOMMERCIAL FIRESIDENTIAL F]MULTI-FAMILY F]MOBILEHOME [-]POOL/SPA FISIGN
SUBTYPE: [—]ADDITION F]ALTERATION F]DEMOLITION ZELEcTRICAL ZMECHANICAL
ZNEW ZPLUMBING [-]RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK TI, Dental office, non structural partitions,sinks,two restrooms, mechanicaWist
W 'y
t-bar cellings,lights,outlets,switches
OCT 11 201
PROJECT ADDRESS 29121 Newport Rd,Suite TEID
ASSESSOR'S PARCEL NUMBER -;�(Qq- nC)- OaC> LOT 345 TRACT 304229 eneived
PROPERTY OWNER'S NAME LJSS-%latGA4-LG ay5�2 W01PA(6
ADDRESS 52es e2t yo e eat B iv&;-
PHONE (951) 248-1100 EMAIL ljcentCaaol.com Q113-11-1
APPLICANT NAME Pacific Dental Services
ADDRESS 2044 California Ave,Corona,CA 92881
PHONE (951) 582-5758 EMAIL webbB@paoden.com
CONTRACTOR'S NAME Donald Webb OWNER BUILDER? F]YES ZNO
BUSINESS NAME Don Webb General Contracting
ADDRESS 8937 Douglas Fir Circle, Riverside, CA92508
PHONE (949) 689-5015 EMAIL webbD@pacden.com
CONTRACTOR'S STATE LIC NUIABER 709664 LICENSE CLASSIFICATION B
00'�O.oo
VALUATION$ $49"W'W SO FT 3?00 L SO FT
APPLICANT"S SIGNATURE DATE 06/0812016
CfTYSTAFF USEONLY
DEPARTMENT DISTRIBUTION CI FY UF MLNIFEE BUSINESS LICENSE NUMBER
SMIP
BUILDING PLANNING ENGINEERING FIRE � GREEN
INVOICE I jCr-M.eq PAIDAMOUNT
AMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
LOWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES C, NO
City of Menifee Building& Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
0(c . 6 www.cityofmenifee.us Inspection Request Line 951-246-6213
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