PMT15-03722 City of Menifee Permit No.: PMT15-03722
29714 HAUN RD. Type: Residential Electrical
'(;kCCEL/4�. MENIFEE,CA 92586
MENIFEE Date Issued:
12/01/2015
PERMIT
Site Address: 25890 MCCALL BLVD, MENIFEE, CA Parcel Number: 335-092-030
92586 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of REMOVE EXISTING TUB REPLACE WITH NEW WALK-IN JET TUB WITH 1 NEW 20A DEDICATED
Work: CIRCUIT
Owner Contractor
DOLLY ADAMS SAFE STEP WALK-IN TUB COMPANY INC
25890 MCCALL BLVD 15262 PIPELINE LANE
MENIFEE,CA 92586 HUNTINGTON BEACH,CA 92649
Applicant phone: 7143738545
DAVID BOYANER License Number:983603
SAFE STEP WALK-IN TUB COMPANY INC
15262 PIPELINE LANE
HUNTINGTON BEACH, CA 92649
Fee Description QtV Amount ISI
Receptacle,Switch, Outlet&Fixture 1 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Electrical 1 5.80
$149.80
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of emirs in the plans and
specifications or from preventing building operations being carded on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise staled,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 Pernit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ I am exempt from licensure under the Contactors'State License Law for IN
following reason:
I hereby affirm under penalty or perjury that I am licensed under provisions of
Chapter 9(commencln with section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence 1
Professions Code n9 q�y license Is in full force an /G� which I must have resided for at least one year odor to completion c
License Class 1� L' n j Improvements covered by this permit, I cannot legally sell a structure that I hav
Expires Signature built as an owner-building if it has not been constructed in its entirety by license
contractors. I understand that a copy of the applicable law,Section 7044 of th
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application i
submitted or at the following Web site:
❑ I hereby affirm under penalty of perjury one of the following declarations: hftii,/Affww.leainfo.ca.gov/calaw.htmI.
I have and will maintain a certificate of consent of self-insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the proped
❑ 1 have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have lead th
section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comp
permit is issue .M wo u:[s'co m psation insurance carder and policy number are: with all applicable city and county ordinances and state laws relating to buildin
c Il construction.I authorize representatives of this city or county to enter the above
Carder) (Ai identified property for the inspection purposes.
--/_t /
Policy.- �'�c/��? / S Expires I 1 ('� Property Owner or Authorized Agent Date
(This section need not be completed if the permit is for City Business License#
one-hundred dollars($100)or less)
HAZARDOUS MATERIAL DECLARATION
❑ 1 certify that in the performance of the work for which this permit is issued,I
shall not employ any persons in any manner so as to become subject to the Will the applicant or re building occupant handle hazardous material or;
workers' compensation laws of California, and agree that if I should become mixture containi a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts spFffied on the Hazardous Materials Information Guide?
Code,I all fo with comply with those provisions./ DYES AD
Applicant; - Date; • _/� Will the Intended use of the building by the applicant or future building
occupant require a p it for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Qualit anagement District(SCAQMD)?See permitting check1k
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guideline
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES ❑ O
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the propose uilding or modified facility be within 1000 feet of the out(
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary ofa ool?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES QKO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending pernitti checklist.I understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section Calif is Health&Safety Code,Section 25505 and 25534 cenceming
3097 Civil Code) ha rdous material reporting.
OWNER BUILDER DECLARATIONS Y NO )
Date /
I hereby affirm under penally of perjury that I am exempt from the Contractor s
License Law for the reason(s)indicated below by the checkmadr(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5. Business and Professions Code: EPA RENOVATION REPAIR AND PAINTING(RRPI
Any city or county that requires a permit to construct, alter, improve, demolish,
or repair any structure, prior to its issuance, also requires the applicant for the The EPA Renovation,Repair and Painting RRP Rule requires contractors
permit to file a signed statement that he or she is licensed pursuant to the P 9(RRP) q
that disturbs paint in apre-1978
provisions of the Contractor's State License Law(Chapter 9 (commencing with receiving compensation for most work
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from licansure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
Violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit:
www.epa.gov/lead or contact the National Lead Information Center at
❑ I, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(5323).
compensation,will do( )all of or( )porling of the work,and the structure Is
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 ❑An EPA Lead-Safe Certified Renovator will be responsible for this projec
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name:
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that B was not built or improved for the Firm Certification No.:
purpose of sale).
❑ I, as owner of the properly an exclusively contracting with licensed
❑No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING : . J
� Menifee
DATE I,3t Mks PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL * RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION (V ELECTRICAL O MECHANICAL
O NEW (*PLUMBING O RE-ROOF-NUMBER OF SQUARES I
DESCRIPTION OF WORK Fwc L c U-) 14-CCJ Loa V, C
1' h-euj Ctrw lt•IDr ))Y'YWctill Yeti LA
PROJECTADDRESS CJ 61VA
ASSESSOR'S PARCEL NUMBER LOT TRACT
City of Menitee
OWNER NAME l- 11 Building & Safety Dept
ADDRESS S Q I /YbQ( L( Yb 1 o
PHONE �S'- 3O -! CAL/ EMAIL
APPLICANT NAME l �+ aVI
� -ek- E'CeIveC
ADDRESS pjPc If✓LQ
PHONE /C 373' p7-ter EMAIL I
CONTRACTOR'S NAME S - 75A�p ' II/� ILA r-Uk CO OWNERBUILDER? OYESkNO
BUSINESS NAME 7
ADDRESS /t� r9 E� / .Q, / • C� �L
PHONE 21V- -3 73• D �tc'��p EMAIL
CONTRACTOR'S STATE LIC NUMBER 3 CS LICENSE CLASSIFICATION
VALUATION $ /V , 0 SO FT L SO FT
APPLICANT'S SIGNATUR DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP I IC
INVOICE po^^ PAIDAMOUNT
AMOUNT 1 ' sV OCASH OCHECKH OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# 0CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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