PMT14-01368 City of Menifee Permit No.: PMT14-01368
29714 HAUN RD. Type: Residential Addition
W CCE1.A— MENIFEE, CA 92586
MENIFEE Date Issued:
05/29/2014
PERMIT
Site Address: 29131 MESA CREST WAY, MENIFEE, CA Parcel Number: 340-420-003
92584 Construction Cost: $1,280.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of ABOVE GROUND SWIMMING POOL 12'X 24',52" DEEP
Work:
Owner Contractor
JACQURLYN BARRY ,
29131 MESA CREST WAY
MENIFEE,CA 92584
Applicant License Number:
JACQURLYN BARRY
29131 MESA CREST WAY
MENIFEE,CA 92584
Phone: 9516721329
Fee Description Qtv Amount 1$1
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
GREEN FEE 1 1.00
$157.07
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
foreited.
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 l0 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
❑ lam exempt from licensure under the Contractors'Stale License Law for the
❑ 1 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 Cade, 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# contr understand that a copy of the applicable law, Section 7044 of the
❑ 1 have and will maintain workers' compensation insurance, as required by siness d Professions Code,is aa,vailable upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this submitter�or at the following Web fie:htto//www leoinfo ca oov/calaw html.
permit is issued.My workers'compensation insurance carrier and policy number are: S Z_
Carrier art�0 er Au oriz Agent Date
Expires Policy# "
rl By y 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. 1 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-
0 1 certify that in the performance of the work for which this permit is issued,I id Mite roperty for the inspectionpurposes.
shall not employ any persons in any manner so as to become subject to the
workers'compensation laws of California, and agree that if I should become 5-2(• /
subject to the workers'compensation provisions of Section 3700 of the Labor pro erty O n or A honz� Agent Date
Code,I shall forthwith comply with those provisions.
ity Bus! s Lice e#
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 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 OYES 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 OYES 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, ❑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 (Chapter9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or OYES 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($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL IfEPOWtING.
compensation, will do( )all of or( )porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale. If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF MENIFEE PLCKNo: PArmitNO;
City of Menifee
29714 Haun Road Building & Safety Dept. Date: Date:
Menifee, CA 92586
Phone: (951)672-6777 MAY 29 20M Amount: Amount: O�
Fax:(951)679-3843
Received
Building Combination Permit
To Be Completed By Applicant
Legal Description: Planning Case: F: L: Rt: R
Property Address: _ Assessor's Parcel Number. �� j`,
2LI12-! Me C - LvCL qZS� :r1V-q
ProjecVTenant Name: Unit#: Near#:
Name: f'. Phone No. Fax No.
eLLl r V I V Y Rsi
Property Address: Unit Number Zi Code
Owner z611 ( S
Email Address:
Name: Phone No. Fax No-
Applicant Address: Unit Number Zip Cade
Email Address:
Name: Phone No. Fax No.
Contractor Address: City State Zip Code
Contractors City Business License No. Contractor's Ctty State of Califomia License No. Classification:
Number of Squares:
Square Footage
V L=a ''Qf� r
Descriptio f Wor N^ t G^ v� / SI Cost of Work:$
C h
Applies ' Sign u e
✓f�(i`. ti. Dale:
7: To Completed ByCity Staff Only.
Indies As R-Received or NIA Not Applicable
5 Compl es sets Of fu di ensioned,drawn to sale plans which include: 1 set of documents which include
❑ Itle Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo TecWSoils 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
❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&petals ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration` Addition" Means/Methods
Work Type:ElRepair Retrofit` Revision to Existing Perrnit`IRequired? 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 YES or NO Indicate all Geo-tech.Haz,Zone
At Project Construction Spdnklered that apply: Coastal Zone
Completion:
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 Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit spedal Casa:elan.
Offida)Anpraual
Expedite Project(s): Child Care City Project Green !ad!L Affordable Housing
For Staff Use Only
Building/Safety Permil specialist I City Planning I Civil Engineering EPWM-Admin Transportation Mgmt. I Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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