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
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