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PMT17-01593 City of Menifee Permit No.: PMT17-01593 29714 HAUN RD. �1-CCELA��.' MENIFEE, CA 92586 Type: Commercial Alteration MENIFEE Date Issued: 08/31/2017 PERMIT Site Address: 29950 MURRIETA RD, MENIFEE,CA Parcel Number: 338-160-017 92584 Construction Cost: $44,996.25 Existing Use: Proposed Use: Description of TENANT IMPROVEMENT TO EXISTING CONVENIENCE STORE, REPLACE EQUIPMENT, Work: MERCHANDISE FLOOR DISPLAYS REPLACE WALL TILES AND FLOORS IN RESTROOMS Owner Contractor PATRICK J ASHER , 12707 HIGH BLUFF DR STE 200 SAN DIEGO, CA 92130 Applicant License Number: CA t 1 Fee Description Qtv Amount 151 Building Permit Issuance 1 27.00 i Inspections not specified 258 258.14 Additional Plan Review Building 165 165.00 Additional Plan Review Building 110 110.00 GREEN FEE 1 2.00 SMIP RESIDENTIAL 1 6.00 New Construction Permit Fee 1 206.98 General Plan Maintenance Fee-Building 1 12.91 General Plan Maintenance Fee-Mechanical 1 0.00 General Plan Maintenance Fee-New 1 10.35 Construction $798.38 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 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_Pe"lt 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 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 ❑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: License Class ice. V (✓�r License No. � L)C ` By my signature below I acknowledge that,except for my personal residence Expires 'J ' ? Signature %LZ /✓iL z' /u�� .�L>��="r 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 structure that I WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by ❑1 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 Cade,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.leainfo.ca.eov/calaw.html. this permit is issued. Policy Ji �`'L- �.� Z C'�� •,�5 Lj� Date PROPERTY OWNER OR AUTHORIZED AGENT ❑I have and will maintain worker's compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which ❑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:L application and the information I have provided is correct.I agree to comply Carrier !' ���'��t �� L-ll\� l.!^� with all applicable city and county ordinances and state laws relating to r� --22 building construction.I authorize representatives of this city or county to Policylt � . Uri C'1i V7,C; xpi. ZL I`� 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 ❑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 p workers compensation laws of California,and agree that if I should become /HAZARDOUS MATERIAL DECLARATION subject to the orker's compensa n provisions of Section 3700 of the Labor Code,I shall f� hwithcomply i os provisions. Will the applicant or future building occupant handle hazardous material or mixture containing a hazardous materiale equal to or greater that the Applicant - �° /✓i/ ,.�-'• ' Date .._ �. i B q amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑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($100,000),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 for guidpli5es CONSTRUCTION LENDING AGENCY ❑Yes o 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 o!ter boundary of a school? (Section 3097 Civil Code) Aes ❑No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD 1 hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of California Health&Safety Code,Section 25505 and 25534 concerning Contractors License Law for the reason(s)indicated below by the hazardous material repo B. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 \.C. Business and Professions Code).Any city or county that requires a permit to Wes` �r j 7 Y Z 1;✓L(�ii t v Date 6' 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 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 licensure receiving compensation for most work that disturbs paint in a pre-1978 and the basis for the alleged exemption.Any violation of Section 703LS 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 ❑I,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 90 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 Contractors State License Law does not apply to an owner of a ❑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 Finn 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: ❑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 rule please fill out the RRP Acknowledgement. WC ` ' JTE CA Lick 949096 CONSULTING • BUILDERS • ELECTRICAL 590 West Central Avenue, Suite F•Brea CA 92821 •Ph 714.990.5025•Fax 714.990,5028 August 30, 2017 CL 0 City of Menifee U 29714 Haun Road W Sun City, CA 92586 V LL Re: Notarized Letter of Authorization O Chevron Station 208064 29950 Murrieta Road Sun City, CA 92584 To Whom It May Concern: This letter serves as authorization for the following WWC/JT Electric employees to act as an agent for the purposes of signing, obtaining information, and submittal of permit packages and applications for the referenced location. Richard Chalfant Monica Molinar Greg Macias , Please feel free to contact me if you have any questions. Thank you, George Johns President 714-745-8965 1 Mobile City of Menifee Building 8 Safety Dept. AUG 3 1 201i Received CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of CaliforT�ia ) County of V f'A % ) On d�.L J�y�1 before me, 1�S m � Pad - Date — Here Insert Name and Titl of the Officer personally appeared �L •.I ,,,�wt S Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the personN whose name(s)CLs/are ubscribed to the within instrument and acknowledged to me that&sheAhey executed the same in ier/theirauthorized capacity(iesand that byherHheirsignature%on the instrument the persons), or the entity upon behalf of which the personKacted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. con0.winaisn I2106i733 WITNESS my hand and official seal. Ibgry PuMk-Calfomis z OEM COW 29 2019 Signature Signature of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Number of Pages: Signer(s) Other Than Named Abo Capacity(ies) Claimed by Signer(s) Signer's Name: / Signer's Name: ❑Corporate Officer — Title(s): ❑Corporate Officer — Title(s): ❑ Partner — ❑ Limited eral ❑ Partner — ❑ Limited ❑General ❑ Individual A orney in Fact El Individual Individual Attorney in Fact ❑Trustee Guardian or Conservator ❑Trustee ❑Guardian or Conservator ❑ Oth y-1 ❑ Other: Si r Is Representing: Signer Is Representing: ©2014 National Notary Association -www.NationalNotary.org - 1-800-US NOTARY(1-800-876-6827) Item#5907 Riverside County Fire Department t Office of the Fire Marshal Section Ri 4eO"2396Mxxel St.W,169.Re7 .CA WWI Ph.19St19S5-IP]Fu(931)955/8BG Palm OeseROfi. 27-933 tas MPnvfias Re.,a 201Pa1m 0eeert.CA 92211 4131 h P601 86 3-8 886 F.p601863J02t Fire Department Clearance/Release Date: 'I I I- W To: ccadson@cityofinen fee.us;brivera@cityofinenifee.us;mbinnall@cKyofinenifee.us;mailto:tbilo@cityofinenifee.us Fax: Tract/Parcel Map#: Permit/Lot#: I l M r N I 015q 3 C N111 -01 CA 3) Job Site Address: I g5O M UV 1 A ET/Nr (w ❑ Final For Recordation Release For Building Permit(s) n Shell Final Only(No Tenant) rl Final For Occupancy rl Release For Residential Sprinkler Installation Building Plan Check Fees Paid,Water Requirement Met-if water applicable r1 Building Plan Check Fees Not Paid rl Residential Sprinkler Plan Check Fees Paid fl Residential Sprinkler Plan Check Fees Not Paid fl Other Fees Cl Fees Not Required If you should have any questions, please contact the appropriate Riverside County Fire Protection Planning office for further assistance. Authorizing Sign h4i For Release —rp-A( I v1/I L1-444MS Print Name Fw C—ft,s 5I1/16 County of Riverside DEPARTMENT OF ENVIRONMENTAL HEALTH FOOD ESTABLISHMENT PLAN APPROVAL NOTICE 0 C) Service Request# 38738 Date 6/20/17 LL1 Project Name Chevron Address 29950 Murrieta Rd. Sun City, Ca 92584 () LL Plans Submitted by Erika Hernandez Phone 213-201-2523 LL 0 Owner Patrick Sullivan Address 12707 High Bluff Dr. Ste. 202 San Diego Phone The plans are now approved subject to the conditions listed below and the attached compliance sheet. 1. Obtain approval from all regulatory agencies prior to final inspection. 2. Provide specification sheets for proposed f real milkshake blending bar freezer device prior to 80% —17Y inspection. Ensure its NSF (or ETL) approved and also provide any cleaning and sanitizing methods included with documentation. Cl� I amm-mow CONSTRUCTION INSPECTIONS: Contact the Plan Checker for a Preliminary Inspection when construction it approximately 80% complete, with plumbing, rough ventilation, and rough equipment installed. Request for inspection should be made at least five (5) working days in advance. A FINAL INSPECTION MUST be made upon completion of ALL work including finished details. APPROVAL to operate shall not be granted, or remodeled areas approved to operate, until the facility has passed the FINAL INSPECTION, and "APPLICATION TO OPERATE" has been completed and PERMIT FEES have been paid. Request for inspection should be made at least five (5) working days in advance. PLANS CHECKED BY E. Rueda, EHS III / L. Lizalcle, EHS III Phone 951-461-0284 1 acknowledge the corrections noted herein and as indicated on the plans and agree to incorporate them during construction: City of Menifee Signature Date Building & Safety Dept. Company Name AUG 3 1 'n�,, Received DEH-SAN-178(Rev 2/16) Corona Hemet Indio Murrieta Palm Springs Riverside-West Riverside-East 2275 S.Main St#204 800 S.Sanderson#200 47-950 Arabia St"A' 38740 Sky Canyon Dr 544 S.Pasco Dorotea 4065 County Circle 3880 Lemon St� Corona,Ca92882 Hemet,Ca 92545 Indio,Ca 92201 Murrieta,Ca 92563 Palm Springs,Ca Riverside,Ca 92503 Riverside,Ca 92501 (951)273-9140 (931)766-2824 (760)863-8287 (951)461-0284 92264 (951)358-5172 (951)955-8982 F�(951)520-8319 Fax:(951)766-7874 F;uc(760)863-8303 Fax(951)461-0245 (760)320-1048 Fax(951)358-5017 (951)955-8988 Fax(760)320-1470 Department Web Site-www.rivcoeh.org