PMT18-03074 City of Menifee Permit No.: PMT18-03074
29714 HAUN RD. Type., Commercial Alteration
MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued: 06/20/2018
PERMIT
Site Address: 29798 HAUN RD, MENIFEE,CA 92586 Parcel Number: 336-381-025
Construction Cost: $6,000.00
Existing Use: Proposed Use:
Description of EXISTING EXTERIOR COLUMN REPAIR
Work:
Owner Contractor
HOPE MEDICAL ARTS PLAZA SOUTH PACIFIC
29792 HAUN ROAD 30619 9TH STREET
MENIFEE, CA 92586 NUEVO,CA 92567
Applicant Phone:7143967300
SOUTH PACIFIC License Number:959430
30619 9TH STREET
NUEVO,CA 92567
Phone:7143967300
Fee Description ON Amount t8l
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
Inspections not specified 129 129.07
GREEN FEE 1 1.00
SMIP COMMERCIAL 1 2.00
$288.14
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
-J 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 D I am exempt from licensure under the Contractor's State License Law for
Professions Code an my license is in full force and effects. the following reason:
License Class 9 7 Ucense No. C O By my signature below I acknowledge that,except for my personal residence
Expires �� W 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
D 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 worker's 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. www.leeinfo.ca.eov/calaw.html.
Policy# Date
D 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 D 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
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 N 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
lify that in the performance of the work for which this permit is issued,
rsHall not employ any persons in any manner so as to become subject to the y CITY BUSINESS LICENSE k
workers compensation laws of California,and agree that if I should become y�HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation rovisions of Section 3700 of the labor , 1`
Code,I shall forthwith col 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 ecified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes
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 HUNORED 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(SCAQMDI?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guI'd lines
CONSTRUCTION LENDING AGENCY D Yes cr
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 outerboo daryofaschool?
(Section 3097 Civil Code) ❑Yes -0
OWNER BUILDER DECLARATIONS I have mad the Hazardous Material Information Guide and the SCAQMO
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
ha ardous material repo ' g�
checkmark(s)I have placed next to the applicable items)(Section 7031.5 � D No
Business and Professions Code).Any city or county that requires a permit to 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 IRRPI
License Law(Chapter9(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( I 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-SOD424-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:
D 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: ZD I p PERMIT/PLAN CHECK NUMBER
PLANNING CASE NUMBER
TYPE: '6E MMERCIAL 0 RESIDENTIAL O MULTI-FAMILY C MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O'DEMOLITION ELECTRICAL O MECHANICAL
O NEW O PLUMBING 0 RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK G h _2 d J2/(O cf'
PROJECTADDRESS Z L ✓ G�• I'`� ��( r -SIC'"7-ZIP ( ��C> `�
ASSESSOR'S PARCEL NUMBER 9 •Act^/ LOT TRACT
OWNER NAME gresP14 z
ADDRESS Gj2 C 7 c
PHONE ! �� lJ �//� ' �� EMAIL
APPLICANTNAME /� t� ki // CL/Z�. /y? h
ADDRESS C) /C`> ( �/ 1/A 5�• �� Sc9 �n ( �S `
PHONE `( ��`C� /�GG /'EMAIL sd/^� Rc iP<Ca U-Q� rZd•'I ,. 'Lc-
CONTRACTOR'S NAME SO u 1`F! ��c L r •�L • 12,-i G�7.OWNER BUILDER? O YES O NO
BUSINESS NAME //�� './ A t rc/ �/ /�,/
ADDRESS `3O (9G(�/( 2 TL� 5r • //a ./L), L/¢
PHONE �(`( _ X/2__ y EMAILSOu'I Tc "Zc)o .4-4p_ f
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
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VALUATION$ J DGO u� SO FT L SQ FT
APPLICANT'S SIGNATURE _ DATE !� f D
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY:tj
CITY OF MENIFEE BUSINESS LICENJONHO
BUILDING PLANNING. ENGINEERING FIRE
INVOICETOTAL 0kF C7 .j y GREEN SMIP
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER C
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
G roe
www.cityofinenifee.us �
MENIFEE
KOLIBRIEN"
rc
June 11, 2018
RE: Structural Inspection and Design Review �.
Foundation,Steel Column and Accessories �r
Hope Medical Center CITY OF MENIFEE
29799 Hann Road BUILDING AND SAFETY DEPARTMENT
Menifee, CA 92586
PLAN APPROVAL
Attn: / -
Ruben Garza REVIEWED BY
South Pacific Commercial Property Services DATE
General Contractor
General Contractor
southpacifrccal@verizon.net 'Approval of these plans shall not be construed to be a permit for,or an
southpacificcal.com approval of,any violation of any provisions of the federal,state or city
Cell 714 396-7300 regulations and ordinances. This set of approved plans must be kept on the
Lic.#959430 jobsite until completion.
Ruben,
A site visit and inspection were performed at the subject location on June 11, 2018. During the
site visit, a limited visual observation was performed on the existing concrete foundation system,
concrete slab on grade, and structural column.
The damage was observed to be limited to be cosmetic damage where the existing architectural
shell surrounding the existing column was destroyed and should be repaired to match existing as
soon as possible.
The existing column and concrete foundation were observed to be structurally sound with no
significant damage.
Additionally, we coordinated work with Herron + Rumansoff, Inc., more specifically, Russell
Rumansoff, AIA, and the general contractor's representative Ruben Garza for a plan for repair.
Lastly, we have reviewed the attached architectural drawing provided by Herron + Rumansoff,
Inc., and we believe it is in conformance with the current version of the California Building Code
as well matches the existing conditions to preserve the integrity of the existing column design.
In our professional opinion, the existing foundation system and steel column are structurally
sound, shall be preserved and protected in place and the newly proposed repairs shall be
constructed in conformance with the current code and the attached design drawing.
Office Copy 1
41593 Winchester Rd., Ste. 200/Temecula, CA 92590/ (951) 252-1034/ info@kolibrlen.biz
KOLIBRIEN®
This certification has been prepared consistent with that level of care and skill ordinarily exercised by
other professional engineers practicing in the same locale and under similar circumstances at the time the
services are performed.No warranty,express or implied, is included or intended by this certification.
It has been a pleasure to be of professional service to you. Please contact us if you have any questions or
if we can be of further assistance.
Respectfully Submitted,
KOLIBRIEN CORP.
Civil& Structural Engineering
Land Surveying
Construction Services
John H.Johnson,P.E., P.L.S. QtypFESS/p VA
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