PMT14-02395 i
I
City of Menifee Permit No.: PMT14-02395
29714 HAUN RD.' Type: Residential Electrical
�A�L_A> MENIFEE, CA 92586
ea".Atot.0 MENIFEE Date Issued: 0 910 6/2 01 4
PERMIT
Site Address: 29276 ANNANDALE RD, MENIFEE, CA Parcel Number: 338-291-021
92586 Construction Cost: $17,500.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING TUB WITH WALK IN JET TUB ADDING 2 RECEPTACLES AND 1 20AMP
Work: BREAKER
Owner Contractor
LEONARD& RUTH MELSBACH SAFE STEP WALK-IN TUB COMPANY INC
29276 ANNANDALE RD 15262 PIPELINE LANE
MENIFEE, CA 92586 HUNTINGTON BEACH, CA 92649
Applicant Phone: 7143738545
JASON DAIGLE License Number: 983603
SAFE STEP WALK-IN TUB COMPANY INC
15262 PIPELINE LANE
HUNTINGTON BEACH, CA 92649
Fee Description Qtv Amount($1
Building Permit Issuance 1 27.00
$154.00
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
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Cod and my license Is in ful orce and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class � -GIO License No. f63(003 who builds or improves thereon, and who contracts for the projects with a
Expires 5.3111015 Signature" licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from licensure under the Contractors'State License Law for the
❑ 1 hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in
compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have
permit is issued.
Policy# built as an owner-building if it has not been constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law, Section 7044 of the
)01 I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http,llwww leainfo.ca.govlcalaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier ST14T s'
c "l QNt1 Property Owner or Authorized Agent Date
Expires 1 ( ZOIS /� Policy# q 0 2 p I/y]
Name of Agent 1 Q) Phone# 61J ✓1'6 ITI ❑ By my Signature below, I certify to each of the following: I am the property
9 owner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
construction.I authorize representatives of this city or county to enter the above-
0 1 certify that in the performance of the work for which this permit is issued,I identified property forth inspection purposes.
shall not emolov any persons in any manner so as to become subject to the
workers'compensation laws of California, and agree that if I should become �-- S Z
subject to the workers'compensation provisi Section 3700 of the Labor Property Owner or Authorized Agent D e
Code,I shall forth 7
ith comply with those provisions.
q 5 201 City Business License#
Date; Applican,
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES P10 EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS GUIDE LINES
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed OYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s)(Section 7031.5. Business and Professions Code: ,n. BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, 61Ji0 SCHOOL?
or repair any structure, prior to its issuance, also requires the applicant for the l
permit to file a signed statement that he or she is licensed pursuant to the
provisions of the Contractor's State License Law (Chapter 9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or cPS INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any (('"`'' CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING.
compensation,will do ( )all of or( )porting of the work, and the structure is PROPERTY OWNE&6R-AH7�IZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY`i OF 1V'1ENIFEE PLCK No: i (' 'O ^-/
29714 Haun Road Date: Date: T �L1 iJ
Menifee, CA 92586 '-
Phone: (951)672-6777 Amount: Amount15410
Fax:(951)679-3843 Ck#: Ck#:
Building Combination Permit G
To Be Completed By Applicant
Legal Description: Planning Case: F:
Prope Address: Assessor's Parcel Number:
2�(rtL 7 0 p iv rJ�N br riF 12D 50 a CA-`2,S
P =me: Floor#:
rr�cV tab Raer U #
Name: P e No. Fax No.
Property Address: Unit Number Zip Cod�2J�
Email Address:
Name- Phone No. Fax No.
3�s�•� , ri,� 45�5 +� �. 2 S
Applicant Address: I Iv — Unit Number Zip Coos
Email Address: P-t
Name: Pho a No. Fax I
SSA �(l ULt J `fUt� 72 N
LI(0s I IL('O /v 95
Contractor Address: City Sta Zi Cotle
1,52(P2 FI iNr Lnl C ! Z1 �_ 2cv C?
ontractor s uny us Mess License No. Contr tor's C„isy�atte of California License No. Classification: C
Number of Squares:
Square Footage AopiN 2 Pe7c -Y'•YI C-L,C"3 t` ` 2(� �}�'✓1/� I�-�?l�
Description of Work: -L�+ — P,I t w K (N-� Cost of Work:$
Applicant's Sig aW Date:
To Be Completed By City:Staff Ohl,
Indicate As R-Received or N/A-Not Applicable
5 Completes sets of fully dimensioned,drawn to sale plans which Include: 1 set of documents which Include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 Y x 11)
❑ Foundation Plan ❑ Cross section ❑ Structural Calculations
❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan 8 Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction 7 Alteration' Addition' MeansiMetnods
Work Type: Repair' Retrofit' Revision to Existing Permit' Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have a Basement?
Y of N
Bldg. Code Occupancy Group Indicate Indicate if YES or NO Indicate !'
Geo-tech.Haz.Zone
At Project Construction Sprinklered that apply: Coastal Zone
Completion: Type(s): C Of O Noise Zone
Required? YES or NO
Listed on Historic Resources Inventor
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board I ILandmark Comm. I Planning Comm.Zoning Administrator
Fee Exempt: City Project Lee.Vehicle Charger I Landmark Seismic Retrofit Special case:Bldg.
OfficialA mvsl
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Building/Safety I Permit Specialist City Planning L'ivil Engineering EPWM-Admm Transportation Mgmt. IRent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
SAS n STEP
WA i1L—K— 1 " —1—4—j EEE3 C d_
Customer: yy�e15�a �r Leo��r�� Installation Layout Representative:`�a k Q
I 3
I
City Building & Safety Dept.
•
SEP D 5 2014
CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENT FieceiVed
PLAN APPROVAL
REVIEWED B S�/Y
DATE
'Approval of these plans shall not be construed to be a permit for,or an v
approval of,any violation of any provisions of the federal,state or city
regulations and ordinances. This set of approved plans must be kept on the
jobsite until completion. dOWN