PMT17-04569 City of Menifee Permit No.: PMT17-04569
29714 HAUN RD. Type: Residential Plumbing
't�VCCELA�i MENIFEE, CA 92586
r.....,'A SA . MENIFEE Date Issued: 1 212 9/201 7
PERMIT
Site Address: 28089 PANORAMA HILLS DR, MENIFEE, Parcel Number: 340-370-033
CA 92584 Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of REPLACE EXISITNG TUB AND TUB/SHOWER VALVE WITH KOHLER WALK IN ACRYLIC TUB.
Work: RELOCATE DRAIN AND WATER LINES FROM LEFT WALL TO RIGHT WALL. INSTALL TWO 20 AMP
DEDICATED CIRCUITS.
Owner Contractor
RICHARD JOHNSON REBORN CABINETS
28089 PANORAMA HILLS DR 2981 LA PALMA AVENUE
ANAHEIM,CA 92806
Applicant Phone:7146302220
JIM BUCKLIN License Number:443682
REBORN CABINETS
2981 LA PALMA AVENUE
ANAHEIM, CA 92806
Fee Description Qtv Amount ISI
Receptacle, Switch, Outlet&Fixture 2 121.00
Plumbing Fixtures and Vents, fixtures 1 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 4.00
General Plan Maintenance Fee-Plumbing 1 5.80
$274.80
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_Permk_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 ❑I am exempt from Iicensure under the Contractor's State License Law for
Professions Cod e(,{end my license is in full force and effect. the following reason:
License Class JV License o. -)- By my signature below l 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 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,for the performance of work for which
this permit is issued. www.leginfo.ca.gov/calaw.html.
Policy# Date
-�&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 r By my signature below I certify to each of the following:)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: s-1 application and the Information 1 have provided Is correct I agree to comply
Carrier ZT� ,S� ^ / o�z.L--J with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# iffnzcs // 7/Gf Expires 332 I,f enter,the above identified property for inspection purposes.
(This section need not to be completed Is the permit is for one-hundred (/LJ.�- g
Date
dollars($100)or less
PRCWERTY OWNER OR AUTHORIZED AG ENT
o 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#
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 forthwi�yFnJcomply with those provisions. WIII the applicant or future building occupant handle hazardous material or a
Applicant l�� Date /��a /t� mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:F ILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes pLIJ0
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($100,0001,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 forguldel'nes
CONSTRUCTION LENDING AGENCY ❑Yes Xo
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) o Yes 7 No
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
Contractors License Law for the reason(s)Indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 pazardous material report
Business and Professions Code).Any city or county that requires a permit to Y�Ytes o No
construct,alter,improve,demolish or repair any structure,prior to its — Date
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER IDA AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRPI
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 Iicensure 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 n for
to he work
that
firms and comply-1978
thanApplicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500J. P P
managers who do the paint-disturbing work themselves or through their
01,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.eoa.gov/lead or contact the National Lead Information Center at
not intended or offered forsale.(Section 7044,Business and Professions 1-BOD-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a D 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. o 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 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.
y.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
S
,Menifee
DATE: PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL C RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK Replace existing tub and tub/shower valve with Kohler walk in acrylic tub.
Relocate drain and water lines from left wall to right wall. Install 2 20 amp dedicated circuits.
PROJECTADDRESS 28089 Panorama Hills Dr ZIP 92584
ASSESSOR'S PARCEL NUMBER 3qp - _�70 �p3a LOT TRACT
OWNER NAME Richard Johnson
ADDRESS 28089 Panorama Hills Dr Menifee, CA 92584
PHONE (760) 271-8414 EMAIL
APPLICANT NAME (/jam D
ADDRESS 24310 Moulton Parkway, Suite 0137 Laguna Hills, CA 92637
PHONE 949.207.3468 EMAIL
CONTRACTOR'S NAME Reborn Bath Solutions OWNER BUILDER? O YES O NO
BUSINESS NAME
ADDRESS 2981 La Palma Avenue Anaheim, Ca 92806
PHONE (714)630-2220 EMAIL
CONTRACTOR'S STATE LIC NUMBER 443682 LICENSE CLASSIFICATION B, C6
VALUATION$ 25996 SO FT L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY:
PERMIT FEE SMIP GREEN
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us
Belays
KOHLER
® 5' BubbleMassageT"" Whirlpool Bath
K-156-LBN
r60"(1524 mm) Max--j
32" p
(813 mm) YI
Max I m
14"
(3i6 mm)
42" (1067 mm)-1
1" 9-11/16" Lumbar
(25 mm)L (246 mm) I—Angle 60
39"
(991 mm)
33-3/4"
0 0 (857 mm) (468 6"
L—ii Q� L I468Imm)
9/16" 3-1116" I ILI1Z-1/4j'Mp h ( 4 8"m) (147/8"m)mm) m 8 m(14 mm)I (7 1 438 m
Required Electrical Service Notes
Two dedicated circuits required, protected with Class A Measur your actual product for rough-in details.
Ground-Fault Circuit-Interrupter(GFCI)or Residual Current Device his product accordin 7 stallation
(RCD). ctions. . ///yy��"
Blower, Heated 120 V,20 A, 60 Hz he hot water supply should be !�/o of the
Surface, Pump: capacity of the bath or greater. Installations will
Heater: 120 V,20 A, 60 Hz vary. an
Technical Information This bath is desigrW_4,fvr,belmi*the-floor drain
All product dimensions are nominal. "'`' installation, ad Glans must be kept on the
Installation: 3-Wall Alcove, Drop-ides z�uons and ordinance This product may require reverse water supply
Drain location: Left jobsite until completion. line installation.
Basin area, bottom: 25-9/16"x 20-9/16" (649 mm x 522 mm)
Basin area, top: 44-1/16"x 22-15/16"(1120 mm x 582 mm)
Weight: 206 Ibs(93.4 kg)
Water depth: 31" (787 mm)
Water capacity: 95 gal (359.6 L)
Electrical component Blower: 120 V, 9.2 A, 60 Hz, 300 W
rating: Heated Surface: 120 V, 0.5 A, 60 Hz
Pump: 120 V, 7 A, 60 Hz
Heater: 120 V, 12 A, 60 Hz, 1500 W
Blower speed: 3-speed
USA/Canada: 1-800-4KOHLER (1-800-456-4537) E BOLD LOOK
Kohler Co. reserves the right to make revisions without notice to product specifications. THE
OF�®�eL��o
For the most current Specification Sheet, go to www.kohler.com.
6-13-2017 10:17
Richard Johnson
28089 Panorama Hills Dr
Menifee, CA 92584
760) 271-8414
TUB
I Fr
I t
I
I I
I 1 EPARVENT
for,or an
federal,state or city e
;.,cio rs ardlnan es, T is set of approved plans must be kept on
letio • I
j bslt until comp /
/ I
% I
/ I
� I
/ I
Scope of Work: Replace existing tub and tub/shower valve with Kohler walk in acrylic tub.
Relocate drain and water lines from left wall to right wall. Install 2 20 amp dedicated circuits to
panel.
CABANET5INC. �m.�.m�.K�.�•
kitchen&bath remodeling specialists Est 1983
May2, 2017
To Whom It May Concern:
This letter shall serve as authorization for the following twelve(12)named individuals have authorization to
pull a Building Permit and/or City Business License on behalf of Reborn Cabinets Inc.
• Kenny Fitzpatrick
• Phillip Murry
• Ron Geisler
• Cesar Sepulveda
• Charles Harmon
• Craig Thorlakson
• Lou Oliverio
• lames Bucklin
• Jeffery Peo
• Kimberly Bucklin
• Bryan Hunt
• Maurice Garcia
Please have the above show picture identification to confirm identity.
Reborn Cabinets Owner/Officer Information
Anthony Nardolillo
CDL: A2076582
Reborn Cabinets, Inc.
2981 E. La Palma Ave.
Anaheim,CA 92806
714-630-2220
CDL: A2076582
C Corporation
Federal ID#95-3855709
License Class B, C6-443682
This Authorization Expires on December 31, 2017
Thank you,
Anthony Nardolillo
CFO
Reborn Cabinets
MANUFACTURING AND DESIGN CENTER SHOWROOM
2981 E.La Palma Ave. 24667 Crenshaw Blvd.Suite A
Anaheim,CA 92806 Torrance,CA90505
Main (888)2-REBORN Main (888)2-REBORN
Fax (714)630.1371 Fax (714)630-371
UaecsroaacElu„RVwewlnd,\osw,�msVemitemho.I:atm.ao�
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT cml.caor=_§1199
ly
State of California l
y County of_ (\ Il
ry \ )C C1�����
` 'nn 1(�, 17�� before me, 1 1 IN Q& . Sn Yf\
Date \` ,.�\ Here 1,Vr Name antl Title afihe 011icet'
personally appeared _ i \ 11�1\U \�
y Name(s)of Si9ner(s)
)
r
? who proved to me on the basis of satisfactory
evidence to be the person whose name's) is/are
subscribed to the within instrument and acknowledged
to me that heMbeftfley executed the same in
hiaft/their authorized capacity(iias), and that by
hislffiledth'etr signatures) on the instrument the
KAYPAWREZ: person(h or the entity upon-behalf of which the
Notary
ulon#210230ia person(s) acted, executed the instrument.
,y = ttofary public-California
Orange county
MY Comm.P fires Mar 6,2019 Iced under PENALTY OF PERJURY under the
I ws of'the State of California that the foregoing
paragraph is-true and correct.
WITN S my hand and 'official seal.
Signs re. <_ i (� •^ 1U� I L
Place Notary Seal Above re of Notary Public % '�
OPTIONAL ��
Though the information below is not required bylaw,R may prove valuable to �ing'on the document
and could prevent fraudulent removal and reattachment of this four document.
Description of Attached Document
Title or Type of Document:
Document Date: Number of Pages:
Signer(s)Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: Signer's Name:
❑ Corporate Officer—Title(s): ❑Corporate Officer—Tdle(s):
❑ Individual ❑Individual
❑ Partner—❑Limited ❑General Top ofthumb here ❑Partner—❑Limited ❑General
r ❑ Attorney In Fact Top of thumb here
Y� ❑Attorney in Fact
I� ❑ Trustee ❑Trustee
❑ Guardian or Conservator ❑Guardian or Conservator
y ❑ Other. ❑Other:
y
Signer Is Representing: Signer Is Representing:
r4
0
`201'0 National Notary Association-N�a-'llCo"n�al"Nso'ftaS+r y.org 1-e�00.US NOTARY(11-8DO-87fi3e(2
.7=) item:K.9
07
Y