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PMT17-03297 City of Menifee Permit No.: PMT17-03297 29714 HAUN RD. Type: Commercial Alteration <;NCCELA—>. MENIFEE,CA 92586 "' MENIFEE Date Issued: 09/2012017 PERMIT Site Address: 30115 ANTELOPE RD, MENIFEE, CA Parcel Number: 364-010-007 92584 Construction Cost: $0.00 Existing Use: Proposed Use: Description of HOURLY INSPECTION FOR C/O&CHANGE OF OWNERSHIP FOR TACO BELL Work: Owner Contractor TACO BELL CORP 1 GLEN BELL WAY IRVINE,CA 92618 Applicant License Number: Fee Description Qtv Amount($1 Building Permit Issuance 1 27.00 Inspections not specified 129 129.07 $166.07 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 Permit_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 Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from Ilcensure underthe Contractor's State License Law for Professions Code and my license is in full force and effect. the following reason: License Class License No. By my signature below I acknowledge that,except for my personal residence Expires 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 structure that I WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by ❑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 workers 70"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 leginfo ca gov/calaw.html. this permit Is Issued. Date Policy# 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 worker's compensation insurance carrier 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 with all applicable city and county ordinances and state laws relating to Carrier 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 ❑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-lows of{alifornia,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject t worker's compensatio visions of Section 3700 of the Labor Co shall forthwith comp) tho provisions. Will the applicant or future building occupant handle hazardous material or a 1, —� f'1 mixture containing a hazardous material equal to or greater that the Z�c-r Date ,may Applicant amounts specified on the Hazardous Materials Information Guide? _n 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 bythe applicantor future building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($300,000),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)7 See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines CONSTRUCTION LENDING AGENCY ❑Yes o No I hereby affirm that under the penalty of perjury there is a construction WIII 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) ❑Yes ❑No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD permitting c .Fun and my requirements under the State of I hereby affirm under penalty of perjury that I am exempt from the Cal' is Health&Safety Code Section 25505 and 25534 concerning Contractor's License Law for the reason(s)indicated below by the azardous material reportin checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Business and Professions Code).Any city or county that requires a permit to Date construct,alter,improve,demolish or repair any structure,priorto its ROPER ER 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 Contractor's 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 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 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.gov/lga 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 ❑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 Firm Certification No.: completion,the Owner-Builder will have the burden of proving that it was ❑No EPA Lead-Safe Certified Firm Is required for this project because: not built or improved for the purpose of sale. ❑I,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. DATE September 19. 2017 PERMITNUMBER Cf"t1 BUSINESS NAME Taco Bell#'3509 TYPE OF BUSINESS fast food restaurant ADDRESS 30115 Antelope Road, Menifee, CA 92584 NAME OF BUSINESS OWNER(S) SD Bell, Inc. ADDRESS(IF DIFFERENT FROM ABOVE) 8100 E. 22nd Street N., Bldg. 300-100, Wichita, KS 67226 PHONE 319-RR4-19100 EMAIL duanPplakrhall rom City of Menlise (vim OWNER OF BUILDING Tarn Rall C nrnnratF Bulldinp A SAM Gant. ADDRESS 1 Glen Bell Way, Irvine, CA 92618 CI. t: PHONE 502-874-1000 EMAIL lease.accounting@yum.com City of Menlfse \j DESCRIBE EXACT USE OF BUILDING: fast food restaurant Bulldincy & Safety Dept. CCD o n nnr? PREVIOUS USE OF BUILDING/SUITE fast food restaurant Received I APPLICANT ACKNOWLEDGEMENT Applicant agrees that the Certificate of Occupancy shall be posted in a conspicuous location, and will operate subject to the City s issuance of the Certificate of Occupancy. I, Duane K. Poynter hereby agree to comply with the above-described terms in this Application for Certificate of Occupancy. DATE 9 19-2017 APPLICANT CITYSTAFF USE ONLY, (PLEASE SIGN I DATE-IF-APPROVED) BUS LICENSE DATE HEALTH DEPT DATE BUS LIC.NUMBER FIRE DATE PLANNING DATE EMWD DATE ENGINEERING DATE BUILDING DATE ENGINEERING INSPECTION(INCLUDE VERIFICATION OF BMP's BUILT PER PLANS/WQMP) REF WQ/SW p APPROVED BY DATE City of Menifee Building£Safety Deportment 29714 Houn Rd. Menifee, CA 92556 951-672-6777 www.citycfinenifee.us Inspection Request Line CATE OF OCCUPANCY TENANT • •R Menifee DATE cl / 19 /1-1 PERMIT NUMBER ADDRESS 3D115 An+e(o e- Roic1 (tfee CA- etas$ BUSINESS NAME —Ucv 1IL 3 G 35p INTENDED BUSINESS USE -rr ast o 1 Cbfaura IS THIS A NEW BUSINESS IN THE CITY OF MENIFEE? YES (CIRCLE ONE) ARE YOU THE FIRST TENANT TO OCCUPY THIS SPACE? YES NO (CIRCLE ONE) IS THE BUILDING EQUIPPED WITH FIRE SPRNKLERS? YES NO (CIRCLE ONE) SQUARE FOOTAGE 2400 NUMBER OF EMPLOYEES NUMBER AND LOCATION OF RESTROOM FACILITIES 2 yes+ o t a 1 s 1 n�a's asr>s-m,.�va•s- to b LIST ANY TOXIC CHEMICALS,FLAMMABLE/COMBUSTIBLE LIQUIDS OR GASES USED OR STORED WITH MSDS SHEETS AND QUANTITIES OF EACH BELOW OR ON A SEPARATE ATTACHED SHEET(S): • ARE YOU MAKING ANY IMPROVEMENT TO THE SUITE OR BUILDING OTHER THAN PAINTING, PAPERING, FLOOR COVERING, MOVABLE CASES,SHELVING OR PARTITIONS NOT O 9" HIGH? YES NO (CIRCLE ONE) • APPLICANT SHALL OBTAIN ALL REQUIRED CLEARANCES AND/OR APPROVALS FROM THE APPROPRIATE WATER DISTRICT AND FIRE DEPARTMENT PRIOR TO ISSUANCE OF ANY BUILDING PERMITS SIGNATURE uir...l DATE 9-/9- PRINTNAME ,- TENANT OWNER / CONTRACTOR / ARCHITECT / ENGINEER (CIRCLE ONE) OCCUPANCY GRP TYPE OF CONST STAFF INITIALS City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityafinenifee.us inspection Request Line 951-246-6213 P.O. Box 8300 C.ISTENM Perris, CA 92572-8300 ` . ,dl ++uw T uvn (951) 928-3777 vvMA P ISTR CLEARANCE FROM FURTHER EMWD RELEASES Business Name: TACO BELL (SD BELL, INC) Date: 06/29/2017 Contact Name: DUANE POYNTER Contact Phone: (913) 219-7401 Contact Address: 8100 22ND STREET NORTH Phone Ext: WICHITA, KS 92584 Email Address: duanep@kcbell.com Contact Fax: EMWD Provides: [ ] Water [ ] Sewer [X] Water and Sewer Requesting Agency: CITY OF MENIFEE—EMAIL: BRIVERA@CITYOFMENIFEE.US, CCARLSON@CITYOFM EN IFEE.US Requesting Agency: RIVERSIDE CNTY ENV HEALTH—TEM/MURR/SUN CITY/MENIFEE—LILIANA LIZALDE LLIZALDE@ RIVCOCHA.ORG Type of Request: [ ] New Single Dwelling [X] Business Service Address: 30115 Antelope Road Menifee CA 92584 APN Number: Tract Number: Lot Number: Business Type: RESTAURANT FOR OFFICE USE ONLY: EMWD Fees: [ ] Paid [X] Not Applicable *Any future alterations involving water usage and/or plumbing configurations should be reported to the District at (951) 928-3777, ext. 4411. Additional Comments: Existing 1000 gallon grease interceptor is acceptable SCARLETT DRAPER—SOURCE CONTROL DIVISION 6/29/2017 (951) 928-6115 EASTERN MUNICIPAL WATER DISTRICT Date Fax Number SC User Reference Number:SC2017000132 WS Reference Number:WS20170000552 n (` � ss :. �! �. � .z it i�yr ♦i �i:. r ykr 'v� °-�r y� .r.. i T _ T m m m Z :3O (D W z N Z A 7 N 0 > n O cn S s N m W _ - G cr -6 CD rt 7 (D D) (D O t9 m ( O O (D .O-. X -j � - n . _ ^^ s c0 .Z7 (D (D C z � f PI) O O O Z � ,i. .. .%. w 7• — w .. 00 �� D -n � N O 0W0 �? c (D7 C -n � vi.LL si CL mr � z m -U o n) mDm Q 0 � Z oa Q' nv n m�' z c v w D Cl) ,_� d � r `° a N -n Cl) D ® v+ 1J z v s o CL 00 -mi �7 n n m o oCD c m vV (D N O = a ?. O 0 (D O Z O - 0 3 � 0 3 L N O- D)CD , O EDCD j cn i O W T CD a ��- S iF �+� S�M � � � �S ... , ^j 'S �,✓� `� P»�•� :s��4j" '�:S P pµ �Y-�_�(y,J�.�" �lT�?s/sM(z.o- �+ �(s%n vJ.(� °�^�_ ^�"c!.