PMT18-00573 City of Menifee Permit No.: PMT18-00573
29714 HAUN RD.
<ACCELA� MENIFEE, CA 92586 Type: Commercial Alteration
MENIFEE Date Issued: 03/23/2018
PERMIT
Site Address: 25904 NEWPORT RD, MENIFEE,CA Parcel Number: 339-200-083
92584 Construction Cost: $8,300.00
Existing Use: Proposed Use:
Description of REPLACE CASE INSTALL NEW REFRIGERATED CASE IN EXISTING STATER BROS MARKET
Work:
Owner Contractor
STATER BROS HILL PHOENIX INC
301 S TIPPECANOE AVE 14350 CHEROKEE PLACE
SAN BERNARDINO, CA 92408 CHINO, CA 91710
Applicant Phone: 7142557200
RMCA ARCHITECTS License Number:729399
, CA
Phone:2134830530
Fee Description Oft Amount I$1
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
Additional Plan Review Building 90 90.00
GREEN FEE 1 1.00
SMIP COMMERCIAL 1 3.00
General Plan Maintenance Fee-Building 1 6.45
$256.52
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of erors 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_Pennit Templateapt 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 contr ictor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and in I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. r1 q 9 the following reason:
1
License Class C30 License No. �"/U q3!j By my signature below I acknowledge that,except for my personal residence
Expires11-30—'I p U Signature +I GL '•- DN+�✓V L., in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATI improvements covered by this permit.I cannot legally sell a structure that I
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 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 www.leainfo.ca.eov/calaw.html.
is
issued./-� 1 Q (j
Policy If vV/Y 7Vdt)4O`1 t n-11 r Date
❑I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
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: application and the information I have provided is correct.I agree to comply
Carrier Lm IV35. ed Iry with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#tA/4- (oa PD l) 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($300)or less
PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the workfor which this permit is issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become
OHAIARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwithhcomply with tlhAus(e7tlprovisions. d Will the applicant or future building occupant handle hazardous material or
Applicant Date y mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAI URE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes TSNo
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 guidelines -- —
CONSTRUCTION LENDING AGENCY ❑Yes 490
1 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) in Yes erNo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
h zardous material report
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Yes ❑ t o 1 Q
Business and Professions Code).Any city or county that requires a permit to Ut Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERI OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant forthe 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)orthat he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis forthe 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 orthrough 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/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 o 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
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
in 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.
The AMS Group PH 909.270.2111
14350 Cherokee Place FX 909.914.71E?
Hr//ph Chino.CA91710 hiliphoeniz.cem
oenix.
February 28, 2018
To Whom It May Concern:
The following individuals are authorized Representatives/Agents for Hill PHOENIX,Inc.They are
authorized to pull Permits,City Licenses or obtain any necessary documentation to fulfill City
Requirements.
Doug Brown
y Joe Burkart
Luke Dean
Matt Franco
Jeff Halley
Danny Lamping
David Lowe
Larry Meyer
Carlos Meza City of Menifee
Shaun Ogas Building Dept.
Paul Panzarella
Nick Tang MAR 2 3 2018
Chad VanNerynen
Randy Wagner
Rob Zamora Received
If there should be any problems or questions,please contact me at 310-345-0597.
Thank you.N4..=mfa
T. David Lowe
Branch Operations Manager
State of California
County of San Bernardino nn� nn
On ha10. 219 1 20 , before me, personally appeared Thomas David Lowe,'
who proved to me on the basis of satisfactory evidence to be the
person(s)whose name(s)is/are subscribed to the within
instrument and acknowledged to me that he/she/they executed
M. RIVERA the same in his/her/their authorized capacity(ies),and that by
Commission Y 2060357 z his/her/their signature(s) on the instrument the person(s),or
Notary Public•California z
y > the entity upon behalf of which the person(s)acted,executed
Orange County the instrument
. M Comm. Expires Apr 4,201 B
i certify under PENALTY OF PERJURY under the laws of the
State of California that the foregoing paragraph is true and
correct
WITNESS my hand fficial seal.
Signature: (1 .Qt-g,t1A ,
Signature of Notary Public
t t a U4. o +-i - L i71.4
-fr:30 thinking'
County of Riverside
DEPARTMENT OF ENVIRONMENTAL HEALTH
FOOD ESTABLISHMENT PLAN APPROVAL NOTICE
Service Request# 40817 Date 2/16118
Project Name Stater Bros#111 Address 25904 Newport Road, Menifee, CA
Plans Submitted by Jesse Lara Phone 213-483-0530
Owner SAA Address SAA Phone SAA
The plans are now approved subject to the conditions listed below and the attached compliance sheet.
1) All equipment and finishes to be verified onsite during the required inspection.
City of Menifee
Building Dept.
MAR 2 3 2018
CONSTRUCTION INSPECTIONS: Contact the Plan Checker for a Preliminary Inspection when construction is
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 Jeff Lojeski, REHS Phone 951-766-2824
I acknowledge the corrections noted herein and as indicated on the plans and agree to incorporate them during
construction:
Signature Date
Company Name
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,Ca 92882 Hemet,Ca 92545 Indio,Ca 92201 Murrieta,Ca 92563 Palm Springs,Ca Riverside,Ca 92503 Riverside,Ca 92501
(951)273-9140 (951)766-2824 (760)863-8287 (951)461-0284 92264 (951)358-5172 (951)955-8982
Fax(951)520-8319 Fax(951)766-7874 Fax(760)863-8303 Fax(951)461-0245 (760)320-1048 Fax(951)358-5017 (951)955.8988
Fax(760)320-1470
Department Web Site-w .rivcoeh.org