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PMT14-01004 City of Menifee Permit No.: PMT14-01004 _ 29714 HAUN RD. MENIFEE, CA 92586 Type: Pool/Spa-Residential MENIFEE Date Issued: 05/06/2014 PERMIT Site Address: 25275 BRIGGS RD, MENIFEE, CA 92585 Parcel Number: 327-420-008 Construction Cost: $40,000.00 Existing Use: Proposed Use: Description of SWIMMING POOL&SPA 812 SO FT Work: Owner Contractor FRANK&LETICIA COTTO 25275 BRIGGS RD MENIFEE, CA 92585 Applicant License Number: MENIFEE, CA Phone: 9092349235 Fee Description (3yl Amount l$) 76ulldinermitIssuance 1 27.00 7IDENTIAL 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 effect. Code:The Contractor's License Law does not apply to an owner of a property License Class License No. 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'COMPENSATION DECLARATION ❑ I am exempt from licensure under the Contractors'State License Law for the ❑ I 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. built as an owner-building if it has not been constructed in its entirety by licensed Policy# contractors. I understand that a copy of the applicable law, Section 7044 of the ElI have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available'qon request when this application is section 3700 of the Labor Code, for the performance of the work for which this sub to oratthe�follo�wirg)NQkfs'ite:hit :F/"uww.le info.ca. ov/cal .ht h permit is issued.My workers'compensation insurance carrier and policy number are: el--`.�-''T (.aflCLot. 65105�2 U/ Property Owner or Authorized Agent Da),,, Carrier Expires Policy# ❑ By 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.I authorize representatives of this city or county to enter the above- ❑ I certify that in the performance of the work for which this permit is issued, I identified property for th spection p urposes shall not employ any persons in any manner so as to become subject to the �� OS *.1 ry/ workers' compensation laws of California, and agree that if I should become dlo subject to the workers'compensation provisions of Section 3700 of the Labor Property Owner or Authorized Agent lifate Code, I shall forthwith comply with those provisions. City Business License# Date; Applicant; WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE IS UNLAWFUL, 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, OYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES El NO EQUAL TO OR GREATER THAN THE AMOUNTS CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? I hereby affirm that under the penalty of perjury there is a construction lending 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 OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address 71 NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDE LINES OWNER BUILDER DECLARATIONS PRINT NAME: I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the reason(s)indicated below by the checkmark(s)I have placed AYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY next to the applicable item(s)(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, O 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 I HAVE READ THE HAZARDOUS MATERIAL provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or AYES INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from Ilcensure 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($500).) CODE SECTI MOTE 50L5I�E 5533 AND 25534 CONCERNING HAZA�DO❑ I, as owner of the property, or my employees with wages as their sole compensation, will do ( ) all of or( )porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; X The Contractor's State License Law does not apply to an owner of a property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). CITY OF ME191lFEE PLCK No: p 29714 Haun Road �rl i i4P®� Date: Date:. -//LJ Menifee, CA 92586 Phone: (951)672-6777 Amount: Amount: Fax:(951)679-3843 Ck#: Ck#: Building Combination Permit To Be Completed By Applicant Legal Description: PlanningCase: F: Property Address: Y I S , Assessor's Parcel Number. a14� oog Projecl(renant Name: Unit#: Floor#: Name: n Phone No. Ca -' Fax No. Property Add re Lljcl�o • 32I- bg6 Owner Yf S (� Unit Number Zip Code Email Address; Qn Ve C bs i ' Name: ,�t �, Phone No. Fax No. /V MUy p Z Applicant Address: nit Number a S 91 Lm k r 1 I f PJ _ �'1 C I Zip °2 L Email Address: Name: Phone No. Fax No. Contractor Address: City State Zip Code Contractor's City Business icense o. Contractor's City State of California License No. Classification: Number of Squares: Square Footage Q 1 Description of Work: CU L Cost of Work:$ u-c- ( � ry O o D,oo O ro Applicant's Signature Date: . E..S %' Be:Completed By CIt¢StaffDnly Indicate As R-Received or N/A-Not Applicable 5 Completes sets of fully dimensioned,drawn to sale plans which include: 1 set of documents which include ❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Gen Tech/Soils Report(on cd only) ❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 Y:x 11) ❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Structural Calculations ❑❑ Floor Plan ❑ S Single Line diagram for elec.services over 400 AMPStructural Framing Plan 8 Details Shoring Plan ❑ Sound Report-Residential Class Code: Indicate New Conslntdion Alteration` Addition" Means/Methods Work Type: Repair' Retrofit' Revision to Existing Permit' Required? YES NO Proposed Building Use(s): Existing Building Use(s): #Buildings: #Units: #Stories: Will the Building Have a Basement? Y of N Bldg.Code Occupancy Group Indicate Indicate if Indicate all FT o-tech.HazZone At Project Spdnklered YES or NOCompletion: Construction that apply: stal Zone Type(s): C of O YESorNOse Zone Required9 Listed on Historic Resources Inventory CITY PLANNING STAFF ONLY APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning.Comm.Zoning Administrator Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit special Case:Offid.)Apprawl Expedite Project(s): Child Care City Project Green Building Landmark I Affordable Housing For Staff Use Only Building/SafetyI Permil Specialist City Planning Civil Engineering EPWM-Admin Transportation Mgml. 1 Rent Control THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY Menifee Building &f Safety Dept. Menifee CA 05/02/2014 MAY 0 5 2014 Frank Cotto Received 25275 Brigs Rd Homeland CA 92583 Phone # 951 322-6686 1 Frank Cotto hereby authorize Samuel Acosta to obtain legal permits For the construction of my swimming pool & spa, order materials and hire subcontractors to the completion of the project. Frank Cotto state of California,County of i e Subscribed and sworn f or affirmed) before me on this day of�J _,2o i`{ by FY-6' 1 lS CO tt't5 proved to me on the basis of satisfactory evidence to be the perso0Kwho appeared be ore m . 9lgn�tu `Pti� JAMKIMBERLRTINEZ Iz Comm #2026089 NOTARY PUBLIC-CALIFORNIA j RIVERSIDE COUNTY }E My Cwn,E)0res Jlele 21,2017 _j >( Al ru U Cc: Ins- z > C) (V CFy_()T_k"IFEE PLIILDING- D SAFETY DEPARTMENT t LU ri _j PLAN APP, on rVVED BY 4 DATE Q� *APpWV31 of these plans s"al!not be construed tobea permit for,oran -aprcv44 any violation of any Proviions of the federal,state or city regulations and ordinances, This set of approved plans must be kept on the jobsite until completion.