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PMT15-01150 i I City of Menifee Permit No.: PMT16-01150 tl 29714 HAUN RD, 'W6CLL MENIFEE, CA 92586 Type: Residential Electrical smx vu sols,+�" MENIFEE Date Issued: 06/01/2015 PERMIT Site Address: 26780 CALLE EMILIANO, MENIFEE, CA Parcel Number: 330-292-003 92585 Construction Cost: $13,000.00 Existing Use: Proposed Use: Description of REMOVE TUB, INSTALL SAFE STEP WALK IN TUB 1 20 AMP BREAKER 2 GFCI OUTLETS Work: Owner Contractor MARYL PAQUET SAFE STEP WALK-IN TUB COMPANY INC 26780 CALLE EMILIANO 15262 PIPELINE LANE MENIFEE, CA 92585 HUNTINGTON BEACH, CA 92649 Applicant Phone: 7143738545 TOM WILKEY License Number: 983603 SAFE STEP WALK-IN TUB COMPANY INC 15262 PIPELINE LANE HUNTINGTON BEACH, CA 92649 Fee Description c yt Amount I$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 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_Blde Permit Template.rpt Page 1 of 1 f 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 Code and my license is in full rce�?ff�St,� Code:The Contractor's License Law does not apply to an owner of a property License Class .Q Licenlse7No. Y �J who builds or improves thereon, and who contracts for the projects with a Expires 51-/.S Signature /�r- 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. built as an owner-building if it has not been constructed in its entirety by licensed Policy# contractors. I understand that a copy of the applicable law, Section 7044 of the L- 1 have and will maintain workers' compensation insurance, as required by Business.and Professions Code,is available upon request when this application is e�ct,on 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto'//vnvw leciinfo ca g_ov/calaw html. permit is issued.My workers'compensation insurance carrier and policy number are: Property caner or uthorized Agent Date Carrier�`{lF C.c�M �' /WS 7 Expires l` j-')(-� ��.yj��J� Policy# �p`�Z I � q Name ofA ent K/Al `"'-" �'-' D Phone# V 3/6"d / D By owner Signature below, certify to each of the following: I am the property g owner or authorized to act on the property owner's behalf. I have read this (This section need Dot be completed if the permit is for application and the information I have provided is correct. I agree to comply one-hu dred 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- ertify that in the performance of the work for which this permit is issued,I identified property for the inspection purposes. shall not employ any persons in any manner so as to become subject to the workers' compensation laws of California, and agree that if 1 should become C subject to the workers'compensation provisions of Section 3700 of the Labor Property Owner or Authorized Agent Date Code, I shall forthwith comply with those provisions. [' l) � City Business License# In J�"' ✓� Date; _ Applicant;.fJ WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL 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 ORA DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE - MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES [�N` 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 FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDE LINES OWNER BUILDER DECLARATIONS I 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 DYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY next to the applicable item(s) (Section 7031.5. Business and Professions Code: ,',,/BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A Any city or county that requires a permit to construct, alter, improve, demolish, E `P SCHOOL? or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the I HAVE READ THE HAZARDOUS MATERIAL provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or DYES 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 010 UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than($500).) CODE OUS MATERIAL SECTION25505f�E 5533ORI,AND 25534 CONCERNING ❑ 1, as owner of the property, or my employees with wages as their sole compensation,will do ( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTkF RIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). SAFETYBUILDING & PERMIT/PLAN CHECK APPLICATION Y, � ' Menifee DATE PERMIT/PLAN CHECK NUMBER H7195"O1150 TYPE: 0 COMMERCIAL 0Y ESIDENTIAL i% MULTI-FAMILY O MOBILE HOME 0, POOL/SPA Q.SIGN SUBTYPE: :%ADDITION ',4LTERATION ' DEMOLITION C% ELECTRICAL Ci MECHANICAL NEW C%,t,PLUMBING C RE-ROOF-NUMBER/OF SQUARES DESCRIPTION OF WORK i VvE� PROJECTADDRESS - 7 2 ffe. m ^��/ A �� {j" 725e 5 ASSESSOR'S PARCEL NUMBER 7��;n •QU7LOT :50 TRACT 4 OWNER NAME ADDRESS 2G�g/�qn�.Y N Z 8 PHONE -�l�� EMAIL APPLICANT NAME C0}'� ,,.[- ADDRESS 1 2v e PHONE ��7�' ��� - c ��� EMAIL CONTRACTOR'S NAME 6 La, (� (�/ (,t /n/D�OWNER BUILDER? OYES : O BUSINESS NAME S �`f `r(A W ADDRESS Z ( ��" L . .� PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER qR� 603 LICENSE CLASSIFICATION VALUATION$ �"� ,�� SO FT L SO FT / APPLICANT'S SIGNATURE DATE CITYSTAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OENIF.NIEEL07�QIp�SS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP a%�f_ 16•j!/V� INVOICE PAID AMOUNT AMOUNT tSq > CASH <%CHECK# CREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT GCASH C%CHECK# -CREDITCARD VISA/MC OWNER BUILDER VERIFIED YES C. NO DL NUMBER NOTARIZED LETTER YES <:i NO City of Menifee Building& Safety Department 29714 Houn Rd. 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