PMT16-04006 City of Menifee Permit No.: PMT16-04006
29714 HAUN RD. Type: Residential Alteration
<A—CCF—LA—> MENIFEE,CA92586
MENIFEE Date Issued: 12/0712016
PERMIT
Site Address: 27683 CAMINO VACUNA, MENIFEE,CA Parcel Number: 336-317-007
92585 Construction Cost: $6,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of REPLACE BATH TUB W/JACUZZI WALK IN SHOWER IN EXISTING PLUMBING&FOOTPRINT
Work:
Owner Contractor
REGINA PARRY DI-LAR INDUSTRIAL SUPPLY INC
27683 CAMINO VACUNA 1541 PARKWAY LOOP STE E
MENIFEE,CA 92585 TUSTIN, CA 92780
Applicant Phone:7145443100
GRANT HOFFMAN License Number:326317
DI-LAR INDUSTRIAL SUPPLY INC
1541 PARKWAY LOOP STE E
TUSTIN, CA 92780
Fee Description Qtv Amount
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
$149.80
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errom 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.Bldg_PerrnR_Template.rpt Page 1 of I
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the project
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State Uce,,e Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure underthe Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class Licenw 2-6 By my signature below I acknowledge that,except for my personal residence
Expires Signature in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot lega Ily sell a structure that I
WORKEWS COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
a 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
this permit is issued. www.leginfo.m.gov/calaw.htmi.
Policy# Date
o I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 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 worker's compensation insurance carrier and policy owner or authorized to act an 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 with all applicable city and county ordinances and state laws relating to
1:2 Lw� VAh, building construction.I authorize representatives of this city or county to
Policy# 5i,666C)1-33a S—WE.pires enterth for inspection purposes.
Thissection need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
a I certify that in the performance of the work for which this permit is issued, -W—idw
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# 641-
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's co pensation prmasions of Section 3700 of the Labor
Code,I shall forthw' c� ovislons.
Fly A�we r Will the applicant or future building occupant handle hazardous material or a
Applicant Jl� Date ec mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ci Yes kNo
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($10,000),IN
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY 0 Yes XN.
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 outerb ndaryofaschool?
(Section 3097 Civil Code) 0 Yes No
OVMER 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 under the State of
California Health§(Sa�ety Code,Section 25505 and 25534 concerning
Contractoes License Law for the reason(s)indicated below by the hazard u mat a porting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 t - Pont' g
Business and Professions Code).Any city or county that requires a permit to uYes 0�1;Nq a%
construct,alter,improve,demolish or repair any structure,priorto its 0 Date
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR ALWORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRP)
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
o 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( )all of or( )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 1-900-424-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 am 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:
o 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
..........Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL 4 RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: CADDITION iOALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW * PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
�-Aej
I
PROJECTADDRESS C� VA(-(41),4
7 LOT
ASSESSOR'S PARCEL NUMBER TRACT
OWNER NAME 'RgAlriA ?AiZ�
S I)--1(9 P �. C I 'A
ADORES —Am" elo VAtAAAA -5 CAA UtW C2-�
PHONE EMAIL If
APPLICANTNAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNEIRBUILDER? OYES @FN0
BUSINESS NAME Cb
ADDRESS 'FAWIWAX4 Loi'4)E 9 al(�5
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ (41 000- SQ FT L SQ FT
<
APPLICANT'S SIGNATURE DATE 12- 6__
CITY STAFF USE ONLY
DEPARTMENT U15TRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOIC PAID AMOU
AM=ET � �E 1 0 CASH 0 CHECK# OCREDITrARD VISA/MC
PLAN CHECK FEES PAID AMOUNT I I OCASH OCHECK# .0CREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building& Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
City of Menifee
Building & Safety Dept.
DEC 0 7
Received
CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENT
P!IAN APP ROVAL
REVIEWED 8
DATE
App:oval of these pliuis ,-. ;strued to�e a permit for,or bn
oPPlovd1of,anyviolatioi— of the federal,state orcit
regulations and ordinance,. w: approved plans must be kept nthe
jobsite until completion.
6030 Shower, Aging-In-Place
go�Wp
All I W-0 a 17.0,
UNW
' QINNNNN�� I . 10
• High gloss acrylic - Molded foot step
• Left or right hand drain - Caulkless installation
• Exclusive Tru-LevelTm base - Shower strainer/drain
• Slip resistant flooring - Factory installed grab bars for age-in-place
• Raised dam to prevent water leakage -Fixed shower head
over the threshold - Hand-held shower with 80" hose
•4-piece molded sectionals city of menifee -24"vertical grab bar and hand-held slider
• Built-in tile flange Building & Safety Dept. . Diverter/thermostatic value
• Multiple integral shelves nrr n - Removable Seat, Curtain, and Rod Assembly
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Left-Hand Model Received Right-Hand Model
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0 2013 Jacuni Lowly Bath For midit1cm.1 Information call Customer SerAce 800-28B4002 wonvjacuzzi.canulechnicalspecs
Refer to Installation Instructions Included Vdth lidurs bar=beginning Installation.Please confirm Product availability and specificattom;before commencing vAth any Installation wo�
PRODUCT SPECIFICATIONS AND AVAILABILITY ARE SUBJECT TO CHANGE WITHOUT NOTICE. M02SWO
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