PMT16-03799 City of Menifee Permit No.: PMT16-03799
29714 HAUN RD. Type: Residential Alteration
<A—CCIEUA—> MENIFEE, CA 92586
MENIFEE Date Issued: 11128/2016
P E R M I T
Site Address: 26904 HOWARD ST, MENIFEE, CA 92586 Parcel Number: 335-302-048
Construction Cost: $7,500.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of REMOVE EXISTING TUB REPLACE WNVALK IN JET TUB, INSTALL CIRCUIT FOR OUTLET, MINOR
Work: DRYWALL PATCH
Owner Contractor
NORMAN SNOWDEN SAFE STEP WALK-IN TUB COMPANY INC
26904 HOWARD ST 15262 PIPELINE LANE
MENIFEE, CA 92586 HUNTINGTON BEACH,CA 92649
Applicant Phone:71143738545
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 carded 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 BidgPermit—Template.ript Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State Ucense Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and a I am exempt from licensure under the Contractor's State License Law for
Professions Cad d my license I.s in full force and effect. the following reason:
UcenseClass_ 7 Qcens\No.Ci�a co 7), By my signature below I acknowledge that,except for my personal residence
Expires,T� Signature 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
o 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.Ieginfo.ca.gov/caTaw.htmI.
this permit is issued.
Policy# Date
o I have and will maintain workees compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the perrormance of the work for which c By my signature below I certify to each of the following:I am the property
this permit Is issued.My worker's compensation insurance carrier and policy owner Or authorized to act on the property owner's behalf.I have read this
number are:,6,,� application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier 7�) 'L�oj building construction.I authorize representatives of this city orcountyto
Policy# Expires I,—t 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
o 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#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
'�rply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Code,I s�� ith c Ixtu
Date mil re containlWa hazardous material equal to or greaterthat the
e ' d an the Hazardous Materials Information Guide?
amounts sppen
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS a Yes oAo
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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidell
CONSTRUCTION LENDING AGENCY 0 Yes X
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 bounda a school?
(Section 3097 Civil Code) 0 Yes 0
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 California Health&Safety Code,Sectiob 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the haz"us mate I reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5
'ZZWk o No
Business and Professions Code).Any city or county that requires a permit to �n ��)L — I�=� Date
construct,alter,improve,demolish or repair any structure,prior to its PROPEII[TY`0�OR AUTHWED AGENT
issuance,also requires the applicant for the permit to file a signed statement
that he or she Is licensed pursuantto the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(FIRM
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 ficensure
•nd the basis for th e a Ileged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint In a pre-1978
residence or childcare facility to be RRP-certified firms and comply with
•n Applicant for a penn it subjects the applicant to a civil pen@ Ity 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
a 1,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 I I all of or( I portion of the work,and the structure is www.epa.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 Contractor's State License Law does not apply to an owner of a o 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 ftwas
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project because:
a 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
-1- P-Menifee
DATE PERIMIT/PLAN CHECK NUMBER PH11(0-
TYPE: F—ICOMMERCIAL EIRESIDENTIAL []MULTI-FAMILY []MOBILEHOME [:]POOL/SPA F]SIGN
SUBTYPE: [-]ADDITION ZALTERATION []DEMOLITION F]EI-EcTRICAL []MECHANICAL
[-]NEW []PLUMBING F1 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK remove ex.tub replace wl walk injet tub , install circuit for outlet minor drywall patch
PROJECTADDRESS 26904Howardst
ASSESSOR'S PARCEL NUMBER -050?,—06G LOT Lj') TRACT (0
PROPERTY OWNER'S NAME NormanSnowden
ADDRESS 26904 Howard St
PHONE (805)260-3367 EMAIL
APPLICANTNAME DaviclBoyaner
ADDRESS 15262 Pipeline Ln
PHONE (714)373-8545 EMAIL Dave@galkos.com
CONTRACTOWS NAME Safe Step Walk In Tub Cc OWNER BUILDER? E]YESZNO
BUSINESS NAME
ADDRESS 15262 Pipeline In Huntington Beach Ca 92649
PHONE (714)373-8545 EMAIL Dave@galkos.com
CONTRACTOR'S STATE LIC NUMBER 983603 LICENSE CLASSIFICATION B
VALUATION $ $7.500.00 SO FT L SO FT
APPLICANT'S SIGNATUIRE��— S' 2Z:2�, DATE /(, (--
OW-7-
DEPARTMENT DISTRIBUTION GREEN SMIP CITY OF MENIFlUtNESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE 1 0
INVOICE I on ( PAIDAMOUNT
AMOUNT 0 (00 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH ',.)CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES NO DLNUMBER NOTARIZED LETTER 0 YES -- NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.citycfrnenifee.u5 Inspection Request Line 951-246-6213
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