PMT18-04436 City of Menifee Permit No.: PMT18-04436
29714 HAUN RD.
MENIFEE, CA 92586 Type: Commercial Alteration
MENIFEE MENIFEE Date Issued: 09111/2018
PERMIT
Site Address: 30007 HAUN RD, MENIFEE,CA 92586 Parcel Number: 360-080-053
Construction Cost; $0.00
Existing Use: Restaurant Proposed Use:
Description of HOURLY INSPECTION FOR C OF 0"KRISPY KREME DOUGHNUTS'CHANGE OF OWNERSHIP
Work:
Owner Contractor
OCEAN FRONT WALK, LLC
17077 EDGEWATER
HUNTINGTON BEACH, CA 92649
Applicant License Number:
MENIFEE, CA
Fee Description QtV Amount Isl
Building Permit Issuance 1 27.00.
Inspections not specified 129 129.07
$156.07
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
1 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 7000)of Division 3 of the Business and 0 I am exempt from licensure under the 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
0I hereby affirm under penalty of perjury one of the following declarations:I licensed contactors.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 fallowing website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit Is Issued. www.IeRinfo.ca.aov/calaw.htm1.
Policy# Date
D I have and will maintain workers compensation Insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Lahpr 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. ut orize representatives of this city or county to
Policy# Expires enterthe ab ide ifi operty for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less Date
PROPERTY WNER ORA 0RIZED AGENT
❑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 became subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if 1 should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Cade,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 ❑Yes ❑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 37060F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑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) ❑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&Safety Code,Section 25505 and 2SS34 concerning
Contractors Ucense Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 Dyes ❑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
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contactors State EPA RENOVATION,REPAIR AND PAINTING IRRPI
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 workthemselves 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( I 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 70",Business and Professions 1-800.424-LEAD(5323).
Cade;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. D No EPA Lead-Safe Certified Film is required for this project because:
0 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.
CERTIFICATE OF OCCUPANCY • PP •
Menifee
DATE 4lael2ata �`\ll\n0 PERMIT NUMBER I2'
BUSINESS NAME Awesome Doughnut,LLC dba Krispy Krems Doughnuts TYPE OF BUSINESS Doughnuts
ADDRESS 370 Knollwood Street,Winston-Salem NO 27103
NAME OF BUSINESS OWNERS) oger man R Glick CEO City of Menefee
ADDRESS(IF DIFFERENT FROM ABOVE) Same as above
PHONE (213)489-2340 EMAIL rlickman@awesomedoughnut.com
OWNER OF BUILDING OCEAN FRONT WALK,LLC Received
ADDRESS 17077 Edgewater Huntington Beach,Ca.92649 Office:(714)483-9559
PHONE (714)483-9559 EMAIL connie.owanfrontwalk@aol.com
DESCRIBE EXACT USE OF BUILDING: Doughnut and coffee
PREVIOUS USE OF BUILDING/SUITE New site
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.
1 Terrell Varvorines hereby agree to comply with the above-described terms in this
Application for Certificate of Occu an y. {`
DATE
APPLICANT
BUS LICENSE DATE ENGINEERING DATE
BUS LIC.NUMBER FIRE DATE
PLANNING DATE EMWD DATE
HEALTH DEPT DATE BUILDING DATE
REMARKS
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofnlenifee.us Inspection Request line
CERTIFICATE • •NCY TENANT DISCLOSURE • ' I. i 4tl �
,tt., Menifee
DATE -gv80tt6 PERMITNUMBER
ADDRESS
BUSINESS NAME Awesome Doughnut,LLC dba Kdspy Kreme Doughnuts CitY of Menifee
INTENDED BUSINESS USE Doughnut Building Dept.
IS THIS A NEW BUSINESS IN THE CITY OF MENIFEE? YES "Pe (CIRCLEUME) 1 2018
ARE YOU THE FIRST TENANT TO OCCUPY THIS SPACE? YES NO ( NQ ia�®
IS THE BUILDING EQUIPPED WITH FIRE SPRNKLERS? YES NO (CIR ON% V �i
SQUARE FOOTAGE WO& Z 22
NUMBER OF EMPLOYEES 27
NUMBER AND LOCATION OF RESTROOM FACILITIES 2
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 OVER 5'9" 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 DATE 4/3012018
PRINT NAME Terrell Varvorines
TENAN OWNER / CONTRACTOR / ARCHITECT / ENGINEER (CIRCLE ONE)
OCCUPANCY GRP TYPE OF CONST STAFF INITIALS
City of Menifee Building &Safety Department 29714 noun Rd. Menifee, CA 92586951-672-6771
www.rityofinenifee.us Inspection Request Line 951-246-6213