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PMT17-01653 City of Menifee Permit No.: PMT17-01653 29714 HAUN RD., Type: Residential Alteration 't;kCCEL/� MENIFEE,CA 92586 MENIFEE Date Issued: 0 512 512 01 7 PERMIT Site Address: 29097 NORTH FORK CIR, MENIFEE, CA Parcel Number: 34"50-012 92584 Construction Cost: $7,500.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of REMOVE EXISTING TUB AND INSTALL WALK-IN TUB. INSTALL 20AMP CIRCUIT FOR OUTLETAND Work: DRYWALL PATCH. Owner Contractor MALCOLM GRUBER SAFE STEP WALK-IN TUB COMPANY INC 29097 NORTH FORK CIRCLE 15262 PIPELINE LANE MENIFEE,CA 92584 HUNTINGTON BEACH, CA 92649 Applicant Phone:7143738545 NICHOLAS LAUER License Number.983603 15262 PIPELINE LANE HUNTINGTON BEACH,CA 92649 Phone: 7148925202 Fee Description Qtv Amount I51 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 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_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 perjurythat 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 licensure underthe Contractors State License Law for Professions Code and rtly_license Is in full force and effeecctom. the following reason: License Class License No. By my signature below I acknowledge that,except for my personal residence Expires 31 Signature G � 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 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,forthe performance of work forwhich www.igginfo-ca.gov/­`calaw.htnil. this permit is issued. Policy p Date have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZEDAGENT 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: 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 building construction.I authorize representatives of this city or county to Policy# E�EYJ___I�A-77 Expires \ l 1 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 4 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 forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a C —� mixture containing a hazardous material equal to or greater that the Applicant — Date .�J z amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes UNLAWFUL,AND SHALLSUBIECT AN EMPLOYERTO 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 ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South IN.-SECTION 3706OF-THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)7 See_permitting checklist for guidelines CONSTRUCTION LENDING AGENCY in Yes 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) in Yes OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD permitting checklist.I understand my requirements underthe State of I hereby affirm under penalty of perjury that I am exempt from the California Contractors License Law for the reason(s)indicated below by the hazardc Health al Safety Code,Section 25505 and 25534 concerning rdo checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 usVtaterialreporting. Business and Professions Code).Any city or county that requires a permit to e °Ye No �_ construct,alter,improve,demolish or repair any structure,prior to�'ts,,� Of rflcttt{e —��- Date PG1y 0W0 ERTY OWNER OR AUTHORIZED AGENT issuance,also requires the applicant for the permit to file a signe �rtF dot that he or she is licensed pursuant to the provisions of the Co o s tote 05iPA RENOVATION,REPAIR AND PAINTING(RRP) License Law(Chapter 9(commencing with Section 7000)of Division 3 of 2 5 The EPA Renovation,Repair and Painting(RRP)Rule requires contractors Business and Professions Cade)or that he or she is exempt from licen 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 ence 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 �,( than($500). 49 ec^��Y red practices.This includes rental property owners and property '�-1 managers who do the paint-disturbing work themselves or through their ❑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 1-800-424-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. ❑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. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION Menifee DATE 37 jS I-7 PERMIT/PLAN CHECK NUMBERFMT —1"0 I LPF) TYPE: O COMMERCIAL IG4SIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION I1ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK F eA110 VC r1� I nS �I AJ �ln1�7C 1v% + 0 N —zo km rc n �a}'1_ 1 PROJECTADDRESS "M0 q 77 /f,/ f 6-IG C_!rc le 2 ASSESSOR'S PARCEL NUMBER ��-W?(D " O 12 LOT _ TRACT bl) OWNERNAME PAICO`WA /�- /�� ADDRESS Md -7 Fork j cje /- �J'1; f'cC LFII /7%�5��1 PHONE 96-1_ 6-6d. 6177 EMAIL APPLICANT NAME ,v WA 5 to L, e ADDRESS JSaG:/ J?' �H g046 >^ q�6�Gl PHONE 7/y F%;2 $otDa EMAIL CONTRACTOR'S NAME SO�� S �/`�4LV1(-�+��v Lz� OWNERBUILDER? OYErIANQ BUSINESS NAME / ADDRESS ��e// LK• NHw� PHONE 7/V 2M S'J-Oa EMAIL CONTRACTOR'S STATE LIC NUMBER 'I?3603 LICENSE CLASSIFICATION VALUATION$ -7-00 SQ FT � L SQ FT APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION d'1 CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN I'W SMIP `/ AMOUNT 01 PAIDAMOUNT INVOICE � I�-{-"I - 0CASH CCHECKk CCREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT O CASH C CHECK# C CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZEDLETTER C YES C NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 Pico ch 'Mkk ) / m 00 -0 cn ) ® /' D « m � 22M m / R -5m -n © - -n ■ w D / 22 � WXo 8 c - A � 0 / ? =i2 � q � / CD -n@ r � m 0r co ® z X t mt r kz � c rp qcn 0 O ƒ ) ƒ q r 2 \ / X RT < 2 r _- D 7 - & § » E k a0 0 § \ \ } m � G) < o f * i $ 2 3 » S Eg � z � qz � � @ r m o " 2 m -n w m rn_ 20 46z -0@ o r- m _ 0 r T /o ( CD CUM t ~ 2 2\ § $ k » D / o CD z ~ ®` % 2 \ § z z < ID CD gtl w w C ID 3 \ £ D 0 > 0 2 O / # 0 | 05*0; CO/11 w�� % TY