PMT17-03487 City of Menifee Permit No.: PMT17-03487
29714 HAUN RD. T Residential Electrical
�ACCELA!? MENIFEE, CA 92586 yam'
MENIFEE Date Issued:
10IO2I2017
PERMIT
Site Address: 27174 AUGUSTA AVE, MENIFEE,CA Parcel Number: 360-441-005
92584 Construction Cost: $7,500.00
Existing Use: Proposed Use:
Description of REMOVE EXISTING TUB, INSTALL NEW WALK-IN JET TUB WITH NEW 20A DEDICATED CIRCUIT,
Work: MINOR DRYWALL REPAIR
Owner Contractor
DANIEL REED SAFE STEP WALK-IN TUB COMPANY INC
27174 AUGUSTA AVE 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 1$1
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 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_Pennit_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 contractors)pursuant to the Contractors State License Law).
Chapter9(commenci with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code ay licenses in full force and e the following reason:
License Class By my signature below I acknowledge that,except for my personal residence
Expir�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
❑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 �v�yw.le¢info.ca.¢ov/calaw.html.
this permit is issued.
Policy# Date
have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
ion 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 worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number ar application and the information I have provided is correcL I agree to comply
Carder with all applicable city and county ordinances and state laws relating to
�? building construction.I authorize representatives of this city or county to
Policy# /zc C7 Expires 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 R
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject tgAhe worker's�ompensation provisions of Section 3700 of the Labor
Cade,I hall fo with ca pl. with those p visions. Will the applicant or future building occupant handle hazardous material or a
Applican Date& mixture containing a hazardous material equal to or greater that the
amo nts nfied on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECUR ORKER'S COMPENSATION COVERAGE 15 ❑Yes N
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($500,000),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 for guldelfips
CONSTRUCTION LENDING AGENCY ❑Yes
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 hotfry of a school?
(Section 3097 Civil Code) ❑Yes`I�SY� ,
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 under the State of
Contractor's License Law for the reasons)Indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable items)(Section 7031.5 hazardous material reporting.
oyes ❑No
Business and Professions Code).Any city or county that requires a permit to Date
construct,after,improve,demolish or repair any structure,prior to Its PROPERTY OWNER OR AUTHORIZED AGENT
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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRPJ
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 Cade)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 than($500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
❑1,as owner of the property,or my employee with wages as their sole employees.For more Information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.aov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-SM-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.if,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or Improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
o I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 70",Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
PERMIT/PLANBUILDING & SAFETY CHECK APPLICATION
`,Menifee
DATE: V - PERMIT/PLAN CHECK NUMBER "Q
TYPE: O COMMERCIAL ®RESIDENTIAL O MULTI-FAMILY O MOBILE HOME C POOL/SPA OSIGN
SUBTYPE: O ADDITION V ALTERATION O DEMOLITION ',"' ELECTRICAL O MECHANICAL
).NEW O PLUMBING I ) RE-ROOF NUMBER OF SQUARES
-
DESCRIPTION OF WORK 'J-1 ��CC. G' h
la J Ut hA PROJECT ADDRESS c� ZIP [C�
5t5C
ASSESSOR'S PARCEL NUMBER LOT LOT TRACT
OWNER NAME I 1�. e,ed\ do &$a4atY^Qa t.
ADDRESS /�L (�, V-\ O 4p1
PHONE EMAIL A
APPLICANT NAME
ADDRESS
PHONE_21C/• 1�-3- .J EMAIL
CONTRACTOR'S NAME 'p I OWNER BUILDER? C1 YES $NO
BUSINESS NAME p lQ
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER l&3(-03 LICENSE CLASSIFICATION
VALUATION $ J 00 SO FT LSQFT
APPLICANT'S SIGNATURE r DATE 2
CITYSTAFF USE DAfL
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY:
on
PERMIT FEE SMIP )C GREEN ( _
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED YES NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
Ciry of lvlenifee Building&Safety Department 29714 Noun Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us
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