PMT18-02535 City of Menifee Permit No.: PMT18-02535
d 29714 HAUN RD.
�v 8$ MENIFEE, CA 92586 Type: Commercial Alteration
MENIFEE MENIFEE Date Issued: 06/2612018
PERMIT
Site Address: 29101 NEWPORT RD,Suite#104, Parcel Number: 364-390-005
MENIFEE, CA 92584 Construction Cost: $88,812.00
Existing Use: Proposed Use: Restaurant
Description of TENANT IMPROVEMENT-ZESTY SHAWARMA AND GRILL 1200 SF
Work:
Owner Contractor
STATER BROS MARKET ,
301 S TIPPECANOE AVE
SAN BERNADINO,CA 92408
Applicant License Number:
MENIFEE, CA
Fee Description O_yt Amount Isl
Tenant Improvement Building 1 696.00
Services, Switchboards, Control Centers& Panels 1 183.00
Receptacle, Switch, Outlet&Fixture 62 421.00
Plumbing Fixtures and Vents, fixtures 12 161.00
Gas System 1 116.00
Hood Served by Mechanical Exhaust 1 219.00
Boilers, Compressors,and Absorption Systems 1 183.00
Building Permit Issuance 1 27.00
Additional Plan Review Building 702 701.58
GREEN FEE 1 4.00
SMIP COMMERCIAL 1 25.00
New Construction Permit Fee 1 408.54
General Plan Maintenance Fee-New 1 20.43
Construction
$3,165.55
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 building 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
I hereby affirm under penalty of perjury that 1 am under provisions of with a licensed contractoT(s)pursuant to the Contractors State License Law).
,Chapter9(commencing with section 7000)of Division 3 of the Business and o I 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 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 1
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 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 is issued. wwsv.leeinfo.ca.eov/calaw.html.
Policy# Date
❑I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 370D 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 with all applicable city and county ordinances and state laws relating to
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($1GO)or less PROPERTY OWNER OR AYTOMED AGENT
O I certify that in the performance of the work for which this permit is issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's 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 comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant 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 o Yes �No
UNLAWFUL,AND SHALL SUB1ECr AN EMPLOYERTO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,10D0),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 forguidelines
CONSTRUCTION LENDING AGENCY ❑Yes m No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility he 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 m 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
Contractor's License Law far the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 'aYes o No Business and Professions Code).Any city or county that requires a permit to ,��51 aLec�c_ Date 'L—9 �- IV
construct,alter,Improve,demolish or repair any structure,prior to its PROPERTY OWNER O ORIZED 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(RRPI
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
❑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( )portion of the work,and the structure is www.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-BOD-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:
O 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: PERMIT/PLAN CHECK NUMBER Q}
PLANNING CASE NUMBER
TYPE: &COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION (P.ALTERATION O DEMOLITION C ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES City Of M
e
Oullding Dep ,
DESCRIPTION OF WORK �Ig1„ o0
MAY p y 2011
PROJECTADDRESS _2.L}'1 0 ` /vsW490,_ go S ie tj ZIP
ASSESSOR'S PARCEL NUMBER LOT TRACT 1
OWNER NAME
n
ADDRESS
PHONE EMAIL APPLICANT NAME zC—JTV ¢} A v R A h h4 G u- 6 J.E
I. ILI S
ADDRESS a 9 1 0 A,- W f +✓C e t D h
PHONE q S 1 —3 9 2.�} )�-� EMAIL ✓ . '!`
CONTRACTOR'S NAME OWNER BUILDER? O YES O NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ Co SQ FT ) 2 ao L SQ FT
APPLICANT'S SIGNATURE DATE�� 2
OTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: ��n" CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE i
INVOICETOTAL I A-1 GREEN - SMIP 5—
OWNER BUILDER VERIFIED OYES 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.cityofm en ifee.us
occ, -' Uy(f 0 ir,F
oCc 10aCA % ? �)L�
CONSTRUCTION AND DEMOLITION • =
ME WASTE DIVERSION PROGRAM
City of Menifee-Public Works/Engineering Department
29714 Haun Road, Menifee, CA 92586 - !� o
Cityof Menifee Ph:951-672-6777 �J
Date;,, - - Case Number-PP,CUP,Etc.Project Description:
-T` i-
APN; Project Address: -�- S'>`2 IOv, Zip Code: d
�I.`IIO) N,ov.P0z �1J /he rl_p
Applicant's Name: Daytime Phone: Estimated Start Dale: mmlddl8Ullding Dept.
RR3J J &L6e 4 - 7I _ ti
Applicant's Company Name: Applicant's Title: Estimated Date of Completion: 7FZ 6 2018
�eS1y 5ilrAWaQMIa AµoGridL v"Nl" v 90 dQ
Contractors Name: Daytime Phone: For RCDWR Only ���0
G^2ly
o n1 PS 4� 9 S � ( S° Approved by:
PERFORMANCEGOALS
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
Please read the following requirements, sign below and initi4kaich box to acknowledge that
you agree to comply with these conditions. Sign here:
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 Buildinq
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/CDUTools/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 Page 1 of
Rev.4/18/18 AY
Waste Authorized Hauler Estimated Estimated
Materials Management and Disposal Site Weight Weight
Method
or Diversion Diverted Landfilled Comments
Facility (in Ibs) (in Ibs)
Brick/Masonry NTvLA
N �1
Cardboard 61 —V4 Il'e L b CA ✓)P"v-t 13 0�
Carpet/Carpet Pads N
Concrete . (ZoY3Pt�)�� w (�Ys.ri^«� Cacf-e,I 2-
Drywall/Gypsum I
ovl°n—
Board m .f1 e� -t
Fixtures (doors, J
toilets, windows) IV IVW /V�l� /✓��
Green Waste
Metal
u LY3 L
Mixed Recyclables
bottles, cans, paper)
Mixed Plastics#1-7
no Film Plastic
Wood VA lh +✓ ; C(2 •2 5 •2.-6-
Other-Explain N
Refuse/Trash _
Total Each Weight Column and Enter Total into Correct Box 0-
Box 1 Total TONS Diverted►
Box 2 Total TONS Landfilled 0-
Box 3 Total Waste Generation for this Project(tons) ►
Box 4 ESTIMATED DIVERSION%for this Project ►
LEGEND FOR BOX OPTIONS
Waste Management Method Authorized Hauler(Contact the Hauler for the project area)
Reuse
Recycle Waste Management Inland Empire
Compost 1-800-423-9986
Salvage http://www.keepinginlandempireclean.com
Landfill
WM Form 2100
Rev.4118118 AY Page 2 of 4