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PMT16-00520 City of Menifee Permit No.: PMT16-00520 _ 29714 HAUN RD. Type: Residential Electrical <7\CCEuJ MENIFEE,CA 92586 MENIFEE Date Issued: 03/01/2016 PERMIT Site Address: 26399 ALLENTOWN DR, MENIFEE, CA Parcel Number: 335-256-015 92586 Construction Cost: $5,000.00 Existing Use: Proposed Use: Description of REPLACE EXISTING TUB WITH NEW WALK-IN TUB, NO NEW CONSTRUCTION,ALL EXISTING Work: PLUMBING WILL BE USED,ADD 30AMP GFCI BREAKER Owner Contractor LAWRENCE RUTH LEISURE LIFE WALK IN TUBS AND SHOWERS 26399 ALLENTOWN DRIVE 2377 GOLD MEADOW WAY MENIFEE,CA 92586 GOLD RIVER, CA 95670 Applicant Phone:9165268333 MARCELA CARLOS License Number. 956300 LEISURE LIFE WALK IN TUBS AND SHOWERS 2377 GOLD MEADOW WAY GOLD RIVER, CA95670 Fee Description 0tv Amount lSl Receptacle, Switch, Outlet&Fixture 1 116.00 Plumbing Fixtures and Vents,fixtures 1 116.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Electrical 1 5.80 $265.80 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_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 I herebyaffirm under with a licensed contractor(s)pursuant to the Contractors State License Law). penalty of perjurythat I am under provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractors State License Law for Professions Code and my license is in full force and eff cctr6.�®� the following reason: License(lass Licens No. l�`s1 By my signature below I acknowledge that,except for my personal residence Expires--q 3l nL Signature in which l must have resided for at least one year prior to completion of WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I have built as an owner-builder if it has not been constructed in Its entirety by ❑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 workers 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.leginfo.ca.gov/calaw.htmL Policy# Date &(ave 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 ❑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., L M application and the information I have provided is correct.I agree to comply Cartier_ /Wj f'y �� / A)S� 7 with all applicable city and county ordinances and state laws relating to tt 'rg r' building construction.I authorize representatives of this city or county to Policy# ✓ w TV Expires "f enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred dollars($100)or less Date PROPERTY OWNER OR AUTHORIZED AGENT ❑I 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 CITY BUSINESS LICENSE# workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 3700 of the Labor Code,I shall forth th complyj�h/Jth/q[ge,provisions. v/ Will the applicant or future building occupant handle hazardous material or a Applicant `�'`�""" Date CD luor mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAI LIRE 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(SC construction or See permitting checklist IN SECrION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Airlines Qua 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) o Yes ❑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 underthe State of Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting. Business and Professions Code).Any city or county that requires a permit to OYes O No construct,alter,improve,demolish or repair any structure,prior to its Date 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 Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP) 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 and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint in a pre-1978 an Applicant fora residence or childcare facility to be RRP-certified firms and comply with p ) permit the applicant to a civil penalty of not more required practices.This Includes rental property property than $500. 4 P p party owners and 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( )all of or( )portion of the work,and the structure is www.eoa.gov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323). Code;The Contractors State License Law does not apply to an owner of a property who,through employees'or personal effort,builds or improves the O An EPA Lead-Safe Certified Renovator will be responsible for thk project 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 completion,the Owner-guilder will have the burden of proving that it was Firm Certification No.: not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because: ❑I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 70",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. BUILDIN & SAFETY PERMIT/PLAN CHECK APPLICATION � Menifee DATE 3 I6 PERMIT/PLAN CHECK NUMBER ao TYPE: O COMMERCIAL IVRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION OIALTERATION O DEMOLITION VELECTRICAL O MECHANICAL ONEW WPLUMBING ORE-ROOOyF/-NUMBEERR�OF SQUARES %� DESCRIPTION OF WORK l� ho-e PROJECT ADDRESS ASSESSOR'S PARCEL NUMBER („Q - ////LOT TRACT PROPERTY OWnNER'S pNApME J'] awrep) e� UVq/ ADDRESS /p� 6 V! ! �7!]"II�C�7(��I 2)� n ' UyI C�'7 <0�5�7" -�/ �- 7a(.6 /6I EMAIL Building & Safety ept. PHONE kw / APPUCANTNAME k/ara*- e�1�-s MAR 0.1 206 ADDRESS �jt7 U �p �kcLv C,T'. PHONE ��- O� `D EMAIL ,�? CONTRACTOR'S NA ME Lei�V I� w^"" �""" (�p i)4WNER BUILDER? 0YES ¢NO BUSINESS NAME //��4 `7 ADDRESS p yr7q"/ PHONE ! JK O ` V�c7✓� EMAIL CONTRACTOR'S STATE LIC NUMBER �1S6 3o0 LICENSE CLASSIFICATION VALUATION$ &TO 0• - SO FT LSQFT APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PUINNING ENGINEERING FIRE GREEN SMIP AMOUNT INVOICE � aU5. PAID AMOUNT ^I Wl05' 0CASH 0CHECK# OCREDITCARD VGAIMC PLAN CHECK FEES PAIDAMOUNT 0C45H 0CHECK# OCREDNCARD VtWMC OWNER BUILDERVERIFIED OYES O NO DLNUMBER NOTARIZEDLETTER O YES O NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-5213 City of Menifee 3u11ding & Safety Dept. Customer: R G j MAR 0 1 2016 t CG Ved House Layout: SIvN SIZ f9\J i r� OF MEN EE ING AN SAFETY ' APPRO AL '' nn 11GG REVIEWED 5 •.4pprcval cf these plans shall not be con approval of,any violation of any provisioi regulations and ordinances. This set of a jobsite until completion.. �: L A 263`�9 / Customer: � � � � � 6) ' `'`uLl Bathroom Layout• =6 (1 City of Menifee Building & Safety Dept. MAR 0 1 2016 Received � ' :PARTMENT I DATEF :o be a permit for,or an 4 the federal,state or city wed plans must be kept on the