PMT16-02025 City of Menifee Permit No.: PMT16-02026
29714 HAUN RD.
�ACCEL/> MENIFEE, CA 92586 Type: Residential Alteration
MENIFEE Date Issued: 0 612 812 01 6
PERMIT
Site Address: 31007 FAIRHILL CT, MENIFEE,CA 92584 Parcel Number: 372-370-025
Construction Cost: $7,500.00
Existing use: 1 &2 Family Residence Proposed use:
Description of REMOVE EXISTING TUB REPLACE WANALK IN JET TUB,ADD 1 NEW CIRCUIT, MINOR DRYWALL
Work:
Owner Contractor
JEANE NICHOL SAFE STEP WALK-IN TUB COMPANY INC
31007 FAIRHILL CT 15262 PIPELINE LANE
MENIFEE, CA 92584 HUNTINGTON BEACH,CA 92649
Applicant Phone:7143738545
DAVID BOYANER License Number: 983603
SAFE STEP WALK-IN TUB COMPANY INC
15262 PIPELINE LANE
HUNTINGTON BEACH, CA 92649
Fee Description Qtv Amount!$)
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-Plumbing 1 5.80
General Plan Maintenance Fee-Electrical 1 5.80
$271.60
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 slated,a permit for construction under which no work is commenced vrithin 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 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 ❑I am exempt from Ifcensure under the Contractor's State License Law for
Professions Code an My license is in full force and ct. the following reason:
License Class Lkens No. �� By my signature below I acknowledge that,except for my personal residence
`��Expires, Signature \ 1� 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
❑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 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 following website:
by Section 3700 of the Labor Code,for the performance of work for which www.leginfo.ca.Rov/calaw.hhnl.
this permit is issued.
Policy#
Date
lafhave and will maintain worker's compensation Insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
lls��eecction 3700 of the Labor Code,for the performance of the work for which o 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 owner's behalf.I have read this
number are:, (� {`. application and the Information I have provided is correct.I agree to comply
Carrier ��JII—C.-I Il-,N_ Vim` with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# c1C:U.Z((- 1 Expires I— enter the above Identified property for inspection purposes.
(This section need not to be completed Is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED 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 become subject to the CITY BUSINESS LICENSE# �J OO yy�✓
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,10 aR-forthwith compiyy w th those provisions. /' WIII the applicant or future building occupant handle hazardous material or a
i�g,a hazardous
rial equal to
that
Applicant , ./ V Date C amounts spmixture e rued on the Hazardous eMaterrials InformationrGuide?e
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS D Yes gNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES WIII the Intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Man$gement District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelin
CONSTRUCTION LENDING AGENCY ❑Yes o
I hereby affirm that under the penalty of perjury there is a construction WIII 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 bound of a school?
(Section 3097 Civil Code) ❑Yes a o
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the
Contractors License Law for the reason(s)indicated below by the Californtt�Health&Safety Code,Section 25505 and 25534 concerning
ha ous material reporting.
checkmark(s)I have placed next to the applicable Rem(s)(Section 7031.5AJYIK o
Business and Professions Code).Any city or county that requires a permit to ^ Date ✓�%-' ( O
construct,alter,Improve,demolish or repair any structure,prior to its PROPERTY OWNER TH R 0 ORI GENT
Issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors 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 work themselves or through their
❑I,as owner of the property,or my employee with wages as theirsole 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.Rov/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 ❑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. o No EPA Lead-Safe Certified Firm is required for this project because:
❑1,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.
CUILDING & SAFETY PERMIT/PLAN CHECK A. • •
',Menifee
DATE b i Lfo PERMIT/PLAN CHECK NUMBER I" Ito
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION /\%ELECTRICAL O MECHANICAL
ONEW W LUMBING ORE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK II t Vx, O Q CR_, 1 / I'J
7W G'c " r_ Ir I IV�ov- Gj
PROJECT ADDRESS DO P,Ir II� C4
ASSESSOR'S PARCEL NUMBER P'' ✓�O LOT �b TRACT 1
OWNER NAME :S-00\,VV9,
ADDRESS 0.L( r 11 C4 •
PHONE 7 rL-Y_ G,�L(f- GS��I //L� EMAIL
APPLICANTNAME �f/�v pp l J Q-0.VLQ✓
ADDRESS �S G 7 jFe Inn - nl �?^ i�� (Go-
PHONE /C(• / ESLO EMAIL
CONTRACTOR'S NAME 'n OWNER BUILDER? O YES V'NO
BUSINESS NAME JA 1 O
ADDRESS 1 s-ZG�- T e �I C C6
PHONE --) I (-/ EMAIL
Q
CONTRACTOR'S STATE LIC NUMBER l 63 6 C] LICENSE CLASSIFICATION
VALUATION$ �G U SO FT L SO FT
APPLICANT'S SIGNATURE DATE �, G
s .
OTYSTAFFUSE
r
DEPARTMENT DISTRIBUTION r `Q CITY OF NIF Ep5U'SI7IE�555LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 1 $MIP O
INVOICE PAID AMOUNT
AMOUNT CASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER O YES C NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menefee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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