PMT18-01275 City of Menifee Permit No.: PMT18-01275
29714 HAUN RD.
�CCELA.. MENIFEE,CA 92586 Type: Commercial Alteration
MENIFEE Date Issued: 05/2412018
PERMIT
Site Address: 30010 HAUN RD, Suite#250,MENIFEE, Parcel Number: 360-690-006
CA 92584 Construction Cost: $94,716.16
Existing Use: Proposed Use: Restaurant
Description of TENANT IMPROVEMENT FOR SEE'S CANDIES, 1408 SF
Work:
Owner Contractor
DONAHUE SCHRIBER REALTY GROUP GARY MADDOX CONSTRUCTION INC
5694 MISSION CENTER ROAD 10133 MEADOW GLEN WAY E
SAN DIEGO,CA 92108 ESCONDIDO,CA 92026
Applicant Phone:9092625445
MENIFEE,CA License Number:598667
Phone:3109939635
Fee Description O_yt Amount lEl
Tenant Improvement Building 1 696.00
Tenant Improvement Sprinkler 1 614.00
Receptacle, Switch,Outlet&Fixture 78 501.00
Plumbing Fixtures and Vents,fixtures 6 131.00
Building Permit Issuance. 1 27.00
Additional Plan Review Building 683 682.63
GREEN FEE _1 4.00
SMIP COMMERCIAL 1 27.00
New Construction Permit Fee 1 435.69
General Plan Maintenance Fee-New 1 21.78
Construction
$3,140.10
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 carded 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
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).
Chapter9(commencing with section 70001 of Division 3 of the Business and o 1 am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class B License No. 6-7 By my signature below I acknowledge that except for my personal residence
Expires 10 31-19 Signature_ �1 —1 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 fallowing 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 syN,sy.leginfo.ca.goy/calaw.html.permit is issued.
Policy N 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 o 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 an the property owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
ry/.j- Ir,✓S C 0 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 0 Yd - y f 'Y(S Z Expires Ohil/ /y 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
o 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 R
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith FFaamplylwith tl(ose provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant w` W ItAIV, Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS oYes ❑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 guidelines
CONSTRUCTION LENDING AGENCY o Yes o No
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 outer boundary of a school?
(Section 3097 Civil Code) - o Yes in No
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
California Health al Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the
hazardous material reporting.
checkmark(s)I have placed next to the applicable Rem(s)(Section 7031.5
Business and Professions Code).Any city or county that requires a permit to oYes in No
Date
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(FIRPI
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.S 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($500). managers who do the paint-disturbing work themselves or through their
a 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( 1 portion of the work,and the structure is www.epa.aov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1.800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
o I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7D44,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
MENIFEE
DATE: � 2D Q O PERMIT/PLAN CHECK NUMBER a
PLANNING CASE NUMBER
TYPE: VCOMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES /�,
DESCRIPTION OF WORK q/ �iLJ Z�/L ALAW S
PROIECTADDRESS �aOJU //w �yZs, ZIP 7��lJT
ASSESSOR'S PARCEL NUMBER 30' (a00- y�D LOT TRACT
OWNER NAME p y E ,e_ /J$�U
ADDRESS
PHONE (2 EMAIL
APPLICANT NAME
ADDRESS
PHON ��D� / < 3- ! �v J� MAIL 69'i1/L`' �'-a•�
CONTRACTOR'S NAME OWNER BUILDER? O YES 2f NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'*A��s
LICENSE CLASSIFICATION
VALUATION$ S/L SQ FT
APPLICANT'S SIGNATURE DATE 3
CITY STAFF USE ONLY -
DEPARTMENT DISTRIBUTION ACCEPTED BY: -, 'n CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE IYA„Iif.�,
INVOICE TOTAL GREEN SMIP
OWNER BUILDER VERIFIED U YES O NO DRIVERS LICENSE.# NOTARIZED LETTER O YES O NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofmenifee.us
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CONSTRUCTION AND DEMOLITION •-
Mt E WASTE DIVERSION PROGRAM
.r
. .'" City of Menifee-Public Works/Engineering Department
29714 Harm Road, Menifee, CA 92586
City of Menifee Ph:951-672-6777
Dale: Case Number-PP,CUP,Etc.Project Description:
-a1A- t
APN: Project Address: QS11 t eA Zip Code:
Applicant's Name: Daytime Phone: Estimated Start D e: mma.:
Applicant's tompany Na A: Applicant's Title: Estimated Date of Completion:
V `-�1 eLQ&U-- if
C^ontracto sName: Daytim(''e�Phone: For RCDWR Only
C�L7 S u �1 -1 Approved by:
PERFORMANCE GOALS
This project will recycle, reuse, compost, and/or salvage a minimum of 50% by weight of the
material and/or waste generated on site.
PERFORMANCE REQUIREMENTS
Please read the following requirements, sign below a nowledge that
you agree to comply with these conditions. Sig
Waste prevention & recycling activities will be discussed at the beginning of each safety meeting
The permit applicant shall provide each NEW subcontractor with copies of completed Form B
(Recycling Plan) and Form C (Reporting Form). The permit applicant shall provide each
subcontractor with a tour of the site's recycling areas.
All recycling containers will be clearly labeled and lists of acceptable and unacceptable materials will
be posted throughout the project site.
Form B - Recycling Plan must be approved by the City of Menifee prior to issuance of Building
Permits.
Form C -Reporting Form must be approved by the City of Menifee prior to issuance of Occupancy
Permits.
Form C - Reporting Form MUST be accompanied by legible letters and/or original receipts including
certified weights, for all materials and/or waste recycled, reused, composted, salvaged, and/or
landfilled.
Waste Diversion must be calculated in TONS (Total Recycled Tons divided by Total Waste Tons= % Recycling Rate)
*Step 1 Enter the "Estimated Weight"of each Diverted or Landfilled material in pounds (Ibs).To convert volume to
weight, refer to: http://www.calrecycle.ca.gov/swfacilities/CDI/Tools/Calculations.htm
*Step 2 Total the"Estimated Weights"of Diverted (Ibs)and Landfilled (Ibs) material and enter in Total box designated for
each.
*Step 3 Convert TOTAL Diverted and Landfilled lbs.to TONS (divide by 2000). Enter TOTAL of Estimated Diverted
TONS in BOX 1. Enter TOTAL of Estimated landfilled TONS in BOX 2
*Step 4 To calculate Total Estimated Waste Generation for this project, add BOX 1 and BOX 2. Enter this Total in BOX 3.
*Step 5 To calculate Estimated Diversion Rate for this project divide BOX 1 by BOX 3. Enter this Total in BOX 4.
WM Form 2100
Rev.4/18/18 AY Page 1 of 4
Waste Authorized Hauler Estimated Estimated
Materials Management and Disposal Site Weight Weight Comments
Method or Diversion Diverted Landfilled
Facility (in Ibs) (in Ibs)
Asphalt
Brick/Masonry
Cardboard
� )cc LG1
Carpet/Carpet Pads
Concrete
Drywall/Gypsum s tj 7 jc,L6
Drywa
Fixtures (doors,
toilets,windows
Green Waste
Metal L/ 3Uz8s
Mixed Recyclables 4!'45`Q r+ 2-oi6'�S
bottles, cans, paper)
Mixed Plastics#1-7
no Film Plastic
Wood u l9sr� l i 2S�4 S
Other- Explain
Refuse/Trash � Y! 2fS
Total Each Weight Column and Enter Total into Correct Box 0-
Box 1 Total TONS Diverted►
Box 2 Total TONS Landfilled ►
Box 3 Total Waste Generation for this Project(tons) 0-
Box 4 ESTIMATED DIVERSION %for this Project ►
LEGEND FOR BOX OPTIONS
Waste Management Method Authorized Hauler(Contact the Hauler for the project area)
Reuse
Rec c e Waste Management Inland Empire
Compost 1-800-423-9986
Salvage http://www.keepinginiandempireclean.com
Landfill
W M Form 2100
Rev.4/18118 AY Page 2 of 4
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