PMT16-03520 City of Menifee Permit No.: PMT16-03520
29714 HAUN RD.
4XCClr--u� MEN IFEE, CA 92586 Type: Commercial Alteration
MENIFEE Date Issued: 1110112017
P E R M I T
Site Address: 30125 ANTELOPE RD, MENIFEE,CA Parcel Number: 364-010-003
92584 Construction Cost; $80,000.00
Existing Use: Proposed Use:
Description of ADA IMPROVEMENTS TO MENIFEE TOWN CENTER TO INCLUDE ROSS, RALPH'S, DOLLAR TREE
Work: &CENTER ADJACENT TO RALPH'S
Owner Contractor
WEINGARTEN REALTY PARTNERS A B C PARKING LOT MAINTENANCE INC
3100 BRISTOL ST 1116 QUARRY STREET
COSTA MESA, CA 92626 CORONA,CA 92879
Applicant Phone:9512702900
JOSH LADEHOFF License Number:753739
A B C PARKING LOT MAINTENANCE INC
1116 QUARRY STREET
CORONA, CA 92879
Fee Description Qtv Amount($1
Plan Check Fee 205 205.00
Building Permit Issuance 1 27.00
Reinspections/Additional Inspections 387 387.21
Administrative Fee 129 129.07
Additional Plan Review Building 65 64.55
Additional Plan Review Building 194 193.60
GREEN FEE 1 4.00
$1,010.43
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 builiding operations being carried an 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.
fiA_l3ldq_Perrnit—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).
Chapterg(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State Uicense Law for
Professions Code and my license is in full force and effect the following reason:
License Class—C 17— License No 71�s7sq By my signature below I acknowledge that,except for my personal residence
Expires 11 -3111 Signature_ In which I must have resided for at least one year priorto completion of
WORKER'S COMPE improvements covered bythis permit.I cannot legallysell a structure that I
NSATiON DECLARATION have built as an owner-builder if it has not been constnitted 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 workees 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 wabsite:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.leAnfo.ca.gov1calaw.htm1.
Policy# !d(0 944"171-1 Date
o 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 permi6s issued.my workees compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
numberare; application and the information I have provided Is correct.I agree to comply
With all applicable city and county ordinances and state laws relating to
Carrier N ckujesr I 6r, K%A t ro building construction.I authorize representatives of this city or county to
Policy# :M I_Exlpire,LJ�Q Lt 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 PROPERiY OWNER OR AUTHORIZED AGENT
a I certify that in the performance of the work for which this permit is Issued,
Ishalinotermil 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 worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. . Will the applicant or future building occupant handle hazardous material or a
nt Data amounts specified an the Hazardous Materials Information Guide?
Applica mixture containing a hazardous material equal to or greater that the
WARNING:FAILURE TO SECURE WORKEWS COMPENSATION COVERAGE IS in Yes /No
UNLAWFUL,AND SHALL 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,OOD),IN occupant require a permit for the construction or madification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQN1DJ?See permitting checklist
IN SECrION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guld It
CONSTRUCTION LENDING AGENCY a Yes rNo
I hereby affirm that under the pena Ity 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 b d ry of a school?
-'a
(Section 3097 Civil Code) ts Yes No
7
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the 5CAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 2550S and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous ter!3aj�lng
Business and Professions Code).Any city or county that requires a permit to riYes W,
construct,alter,Improve,demolish or repair any structure,prior to its O!L4—� Date t�(
issuance,also requires the applicant for the permit to file a signed statement PROPERTV(:OW��R AUTHORIZED AGENT
TION.R
that he or she Is licensed pursuant to the provisions of the Contractor's State EPARENO TION.REPAIR AND PAINTING fRRP)
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-certirted firms and comply With
an Applicant for a permit subjects the applicant to a civil penalty of not more required practic�.This includes renta I property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
u 1,as owner of the propeft or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do I )all of or I I portion of the work,and the structure is www.epa.goyllead or contact the National Lead Information Center at
not intended or offered for sole.(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 cs 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 am 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:
o 1,as owner of the property am excluilvely 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 proje ct does not comply with EPA RRP rule please fill out th e RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE lei I?n% PERMIT/PLAN CHECK NUMBER 0-�?5;).o
TYPE: 9<0MMERCIAL C" RESIDENTIAL OMULTI-FAMILY OMOBILEHOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION �61LTERATION ODEMOLITION CELECTRICAL OMECHANICAL
ONEW OPLUMBING 0- RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Nv�-
PROJECTADDRESS 50 Att-exV02t=
ASSESSOR'S PARCEL NUMBER �4 _ DIVOWDLOT TRACT
OWNER NAME vze-u�-,
ADDRESS -Sloc� 5-c- COSTI L�� Ok
PHONE 11q- EMAIL
APPLICANT NAME
ADDRESS
PHONE LIPS- ILLW IL( EMAIL 1_&&C_u dokn; I - C jaLA
CONTRACTOR'S NAME kef -
LcrC %qv�keV,,*e OWNERBUILDER? OYESV<O
BUSINESS NAME WIL
ADDRESS t\L%� lav&tLVV�4 %T %�U 6-AU CAN -
PHONE !Tz I - 7_0 - -xq 0 L) EMAIL -row
CONTRACTOWS STATE LIC NUMBER LICENSE CLASSIFICATION C-re
VALUATION$ SQ FT Lij 4!;� L SO FT
APPLICANT'S SIGNATURE DATE 101-L7 1 )6
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FiRE GREEN SMIP
INVOICE
AMOUNT PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# C)CREDITCARD VISA/MC
NO
OWNER BUILDER VERIFIED OYES 0 No DILNUMBER NOTARIZED LETTER 0 YES 0 Tj
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us inspection Request Line 951-246-6213