PMT17-04311 City of Menifee Permit No.: PMT17-04311
29714 HAUN RD.
f( - CCEL/> MENIFEE,CA 92586 Type: Residential Alteration
MENIFEE Date Issued: 1 210 6/2 01 7
PERMIT
Site Address: 26891 SUN CITY BLVD, MENIFEE,CA Parcel Number: 337-342-012
92586 Construction Cost: $7,500.00
Existing use: 1 &2 Family Residence Proposed use:
Description of REMOVE EXISTING TUB, INSTALL NEW WALK-IN TUB, INSTALL NEW 20AMP CIRCUIT FOR
Work: OUTLET, DRYWALL AND PATCH
Owner Contractor
MARTHA TASSARI SAFE STEP WALK-IN TUB COMPANY INC
26891 SUN CITY BLVD 15262 PIPELINE LANE
MENIFEE, CA 92586 HUNTINGTON BEACH, CA 92649
Applicant Phone:7143738545
DAVID BOYANNER License Number: 983603
SAFE STEP WALK-IN TUB COMPANY INC
15262 PIPELINE LANE
HUNTINGTON BEACH, CA 92649
Fee Description 01tr Amount f$1
Plumbing Fixtures and Vents,fixtures 1 116.00
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 6.45
General Plan Maintenance Fee-Plumbing 1 5.80
$285.32
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 Cade 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_Pem it_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 o I am exempt from licensure under the Contractors State License taw for
Professions Cade anOj3iy license is in full force and effect. the following reason:
License Class ense`No. T63C (0 By my signature below 1 acknowledge that,except for my personal residence
Expires — -I'FS Signature --)C in which l must have resided for at least one year priorto completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
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 far 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 Seaton 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.leRinfo.ca.eov/calaw.html.
Policy# Date
o I have and will maintain workers compensation Insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ❑By y signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and polity ner or authorized to act on the property owners behalf.I have read this
number are: I /� application and the information I have provided is correct.I agree to comply
Carriers V "`. i u�- with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#0002.f-/ Expires <::�e terth above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred \�\1 Date )a` �n '
dollars($100)or less FROPERW 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# 0 �V
workers compensation laws of California,and agree that If I should become HAZARDOUS MATERIAL DECLARATION
subject to the workeNcompensation provisions of Section 3700 of the Labor
Cod , rthwith c nply`with thosseep\rovisions. ,s Will the applicant or future building occupant handle hazardous material or a
ApplicantU Date I D—`(9 -� mixture contatninga hazardous material equal to or greater that the
amounts sppifred an the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes 40
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 Quairequire
anagement District(SC construction
or modee ification
gchecklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo Coast
Airlin
CONSTRUCTION LENDING AGENCY o Yes o
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 bounds ofa school?
(Section 3097 Civil Code) o Yes o
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
1 hereby affirm under penalty of perjury that 1 am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)Indicated below by the Californ a-Heaith&Safety Cade,Section 25505 and 25534 concerning
theckmark(s)I have placed next to the applicable item(s)(Section 7031.5 ha ous material reporting.D Na
Business and Professions Cade).Any city or county that requires a permit to Date
construct,alter,Improve,demolish or repair any structure,prior to its PROPERTY NER OR Al1THORIZE 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 Contractors 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 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 praperty,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.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80D-424-LEAD(5323).
Code;The Contractors 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 it was
not built or improved for the purpose of sale. D No EPA Lead-Safe Certified Firm Is required for this project because:
D I,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.
FETY PERMff/PLAN CHECK APPLICATION
DATE: G _ PERMIT/PLAN CHECK NUMBER Pl a t
TYPE: O COMMERCIAL ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADD ION ALTERATION O DEMOLITION Sa:ELECTRICAL O MECHANICAL
O NEW MBING O RE-ROOF NUMBER OF SQUARES
atDESCRIPTION OF WORK ff I� J`I LAk �Q� (tifC� Q �/k(
PROJECTADDRESS I) L I �,��J'C�L(-1 l, 2(�� ZIP /�
ASSESSOR'S PARCEL NUMBER e - O� � LOT 613 TRACT ��D4"
OWNER NAME
ADDRESS
PHONE EMAIL
APPLICANT NAME U L K A C>- i"
ADDRESS I ( 1•e VL<Z-J I
PHONE (G(. "'j �C(� EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES O
BUSINESS NAME
ADDRESS ��� / /�C� l ��I, ' J e� ca `1
PHONE /�(. 373• �SL(�' EMAIL
CONTRACTOR'S STATE LIC NUMBER 7,4,0c03 LICENSE CLASSIFICATION P3
VALUATION$ J C_ (�) SQ^FT CI V L SO FT /
APPLICANT'S SIGNATURE ) / -- DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED CITY OF MEN��USINF$,$U NSE NUMBER
BUILDING PLANNING ENGINEERING FIRE �-y
PERMIT FEE a ,� p SMIP GREEN l
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED 0 YES C NO DRIVERS LICENSE!! NOTARIZED LETTER 0 YES 0 NO
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