PMT14-00994 City of Menifee Permit No.: PMT14-00994
29714 HAUN RD. Type: Pool/Spa-Residential
�CCE1-.I'k MENIFEE, CA 92586
MENIFEE Date Issued: 05/02/2014
PERMIT
Site Address: 29524 WAGON CREEK CV, MENIFEE, Parcel Number: 339-414-010
CA 92584 Construction Cost: $31,400.00
Existing Use: Proposed Use:
Description of GUNITE POOL AND SPA 430 SQ FT
Work:
Owner Contractor -
ANDRES&MARIA RODRIGUEZ CAL/PACIFIC POOLS&SPAS INC
29524 WAGON CREEK COVE 17940 VAN BUREN BLVD -
MENIFEE, CA 92584 RIVERSIDE, CA 92508
Applicant Phone: 9517762002
CAL/PACIFIC POOLS &SPAS INC License Number: 652876
17940 VAN BUREN BLVD
RIVERSIDE, CA 92508
Fee Description Qtv Amount
1?11� P. fol/ln GroUhd3a.,, 17 :j
Building Permit Issuance 1 27.00
SMIP RESIDENTIAL 1 4.00
$500.00
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_Permit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9 (commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Code and my license is in full force and el fect. Code:The Contractor's License Law does not apply to an owner of a property
License Class (X3 License No 1 who builds or improves thereon, and who contracts for the projects with a
Expires )" Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENS ION DECLARAT N
❑ I am exempt from licensure under the Contractors'State License Law for the
ElI hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in
compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have
permit is issued.
Policy# built as an owner-building if it has not been constructed in Its entirety by licensed
contractors. I understand that a copy of the applicable law, Section 7044 of the
'� have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
s@ction 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htc, www leginfo.ca.gov/calaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
,P Property Owner or Authorized Agent Date
Carrier
Expires /i&-311 r Policy# Si�✓L /® fso�3
my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
construction, thorize-rapre ntatives of this city or county to enter the above-
El I certify that in the performance of the work for which this permit is issued,I identified pert a inspection rposes.
shall not employ any persons in any manner so as to become subject to the
workers' compensation laws of California, and ree that if I should become
subject subject to the workers'compensation provisions ti n 3700 of the Labor rCItyBu,
ut rized A ant Date
Code, I shall forthwith comply with thos ovisi
�/ ess License#
Date; $ ^Z^, / Applicant;
WARNING: FAILURE TO E: URE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS LAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DYES OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ONO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name AYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ❑NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed DYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable items)(Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, ❑NO SCHOOL?
or repair any structure, prior to its 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 License Law (Chapter 9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or ❑YES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than ($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL I EPORfING.
compensation, will do( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF MENIFEE PLCK No: Permit No:
29714 Haun Road Cityof Menifee
Menifee, CA 92586 Building & Safety Dept. Date: Date:
1
Phone: (951)672-6777 MAY 0 2 2014 Amount Amount:
Fax:(951)679-3843 Ck#: Ck#:
Building Combination P(iWived
To Be Completed By Applicant
Legal Description: cc� 2 Planning Case: F: L: Rt: R:
Property Address: Assessor's Parcel Number.
�9a"1.v 60V 696-01/G ef%4-16- -;'3TL 511V-0/o - 3
Projectlfenant Name: Unit#: Floor#:
A"/6vFz
Name: �/ Phone No.
4F&c No.
Property Address:
Owner �YrrL 5/ �jf6Unit Number Co
Email Address:
Name:
Applicant Address:/ 9 y8 .1GI� Unil Number Zip Code
/Av c� P3J3�
Email Address:
Name: 00�/ /G /00 c.S PhxxNo.
• one No. Fa
� s/• 776-�y 7r/• 7>fS2aa�
Contractor Address: Cin Stat{ Zipfode/ --!d as o $
ontractor's Ity Busmess Ucense Mo. Contractor's city rState
Of California License No. Classification: C—r-2
Number of Squares:
Square Footage 3v
Description of Work: fol
st of Work:$ y� ad
Z/.�D rE` �6G0 J1A r
Applicant's Signature ,
te: 5 - 7 /
o Be Completed By,Ciry Staff Only ' -
Indicate As R-Received er N/A-Not Applicable - -
- ff'Comptele"alli of fully dimensioned.drawn to site plans which Include: 1 set of documents which include
�.�
Tills Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cd only)
❑ Plat/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 %.x 11)
❑ Foundation Plan ❑ Structural Calculations
❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for else.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan I ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition' Means/Methods
Work Type: Repair' Retrofit` Revislon to Existing Permit' Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: 4 Stories: Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate Indicate it Indicate all Geo-tech.Haz.Zone
At Project Sprinklored YES or NO -
Completion: Construction that apply: Coastal Zone
Type(s): C of O YES or NO Noise Zone
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board4LandmarkComm. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Chargerandmark Seismic Retrofit spec case:aril,Offidatik omvul
Expedite Project(s): Child Care City Project reen But
Landmarki Affordable Hauling
For Staff Use Only
Building,/Safely Permit Specialist Cily Planning Crnl Engineering EPOVM-Admin Transportation fvlgml. Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY