PMT14-02413 i,
City of Menifee Permit No.: PMT14-02413
29714 HAUN RD. Type: Pool/Spa-Residential
G` L MENIFEE, CA 92586
MENIFEE Date Issued: 09/08/2014
PERMIT
Site Address: 29037 WAYFARER RD, MENIFEE, CA Parcel Number: 333-522-002
92585 Construction Cost: $30,000.00
Existing Use: Proposed Use:
Description of INSTALL GUNITE POOL&SPA
Work:
Owner Contractor
RICHARD MADRIAGA
29037 WAYFARER ROAD
MENIFEE, CA 92585
Applicant License Number:
RICHARD MADRIAGA
29037 WAYFARER ROAD
MENIFEE, CA 92585
Phone: 9513238417
Fee Description ,4�tr Amount isl
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 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'State 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 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
❑ 1 have and will maintain workers' compensation insurance, as required by Business an rofessions Code,is available upon request when this appglication is
section 3700 of the Labor Code, for the performance of the work for which this submitted r t t e following Web site:Ird ://www.le info.ca. ov c aw. Rml.
permit is issued.My workers'compensation insurance carrier and policy number are: t
Carrier Propel Ow orized Agent Dat
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-
❑ 1 certify that in the performance of the work for which this permit is issued, I identif d'p op rty for the inspection purposes.
shall not emolov any persons in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become G
subject to the workers'compensation provisions of Section 3700 of the Labor Pro e r or Authorized Agent Date
Code,I shall forthwith comply with those provisions.
City u 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
($700,000), IN ADDITION TO THE COST OF COMPENSATION, ❑YES 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 ❑NO 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 DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ❑NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS GUIDE LINES
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 LIVES 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 DYES 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
acicivil penalty of not more than($500).) CODE SECTION
E 3 MON 25505RIAL1�5533',AND 25534 CONCERNING
tp I, as owner of the property, or my employees with wages as their sole
compensation, will do (�.l all of or( ) porting of the work, and the structure is PROPERTY OWNER ORAUTHORIZED AGENT
not intended or offered far^sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF MENIFEE PLCK No: Permit No:
City of Menifee 13
29714 Haun Road Building & Safety Dept. Date: Date:
Menifee, CA 92586 1119,1m
Phone: (951)672-6777 SEP 0 8 2014 Amount Amount:
Fax:(951)679-3843 Ck#:
Received
Building Combination Permit
To Be Completed By Applicant
Legal Description: - Planning Case: F: L: Rt: R:
Property Address: {� Assessor's Parcel Number:
.G
Project/Tenant Name: Unit#: Floor M
Name: % r, a Poe o. 0/ Fax No.
Owner r'
Property Address: nit N ber / Zip Code Q
G I sZb
Eail Addre s: IIflme: - one Fax No.
ritvii- ( C' �� - 2� l
Applicant Address: - UnitNuhaber Zip Code
Email Address:
Name: one No. Fax No.
Contractor Address: City State Zip Code
Contractor's City Business License No. Cdntractor's City State of California License No. Classification:
Number of Squares:
Square Footage
Description of Work: ' Cost of Work:$
Applicant's Signature.
�� Date:
i !
_ To Be Completed By City Staff Only /
i 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 ❑ Geo Tech/Soils Report(on ed only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8%x 11)
❑ Foundation Plan ❑ Cross Section ❑ Structural Calculations
❑ Plumbing Plan ❑ Single Line diagram for elec.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` 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 YES or NO Indicate all Geo-tech.Haz.Zone
At Project Construction Sprinklered that apply: Coastal Zone
Completion: Type(s): Coto Noise Zone
Re wred? YES or NO
q 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 pecial ase:Side.
Official Approval
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Building/Satety I Permit Specialist I City Planning I Civil Engineering EPWM-Admen I Transportation Mgmt. IRent Contrel
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
;�,1 ofYR7 yEgB
COUNTY OF RIVERSIDE
BUILDING AND SAFETY DEPARTMENT
E
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w
re`yCe�'r SAFET101'4p4�F DOOR PROTECTIVE VERIFICATION FORM
Mike Lara POOL AND SPA BARRIERS
Director
BSP No.
The California Swimming Pool Safety Act (Health and Safety Code Section 115920) mandates
that all doors providing direct access from the residence or garage to a new swimming pool and/or
spa be provided with door exit alarms and/or self-closing and self-latching devices, unless the pool
and/or spa is provided with an approved safety cover or the pool and/or spa is isolated from direct
access to the home or garage by an approved pool fence and gate enclosure.
IF THE DOOR EXIT ALARM OPTION IS UTILIZED (This option may not be used on the
garage man-door; it is only allowed to be used on the residence doors):
a) The alarm must be listed by Underwriters Laboratories (UL) as an exist alarm.
b) The alarm must sound an audible, continuous warning when the door is opened or left ajar.
c) The alarm deactivation mechanism must be mounted at least 54 inches above the floor.
d) The alarm may be battery-operated or may be connected to the building's electrical wiring.
IF THE SELF-CLOSING AND SELF-LATCHING OPTION IS UTILIZED (This option is allowed
to be used on either the residence or garage man-doors):
a) The release mechanism for the self-latching device shall be placed no lower than 54 inches above
the floor.
b) The self-closing device must cause the door to close and latch automatically, without any other
assistance.
I, kui01 ¢p l✓tpWLI ALA own and live in the dwelling located at:
(Print Property Owner's Name)
Z�io37 w,4yFh2rrL (zo. i4le Jce, cA, °32-f' gs and do hereby verify that
(Address)
the door alarm(s) and/or self-closing and self-latching devices on all doors providing direct
access to the pool and/or spa area from the home and/or garage have been installed in
compliance with the conditions listed above and with the manufacturer's installation
instructions and further that they have been tested and do function properly.
I have read and understand the above requirements and affirm by my signature
that all equir d items mentioned above have been properly installed and tested.
r t re of Property Owner Date
ATTENTION OWNER-OCCUPANT
This is a voluntary verification procedure which recognizes that it may not be convenient or possible for you to
have an adult present in the home when the inspection is needed, and therefore allows you to perform those
limited inspections identified above. If you prefer a County Building Inspector to perform the exit alarm or self-
closing and self-latching device inspection for the door(s) providing direct access from the home or garage to
the pool area, you must arrange to have an adult present during the inspection to allow entry into the home. A
fence and gate inspection is also required to be conducted by the County Building Inspector prior to filling the
pool or spa with water.
4080 Lemon Street . 2nd Floor. P.O. Box 1629 . Riverside . CA . 92502-1629
Telephone: 951-955-1800 . Fax: 951-955-1806 w .rctlma.org
Form 284-95 05/2012
w County of Riverside
Of�Ca�C SAFETY O�QP4�a Department of Building and Safety
AUTHORIZATION OF AGENT TO ACT ON PROPERY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my
personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to
apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for
my project.
Scope of Construction Project (or Description of Work): &1 Mrs 10vc, rl?u j
Project Location or Address: 2`1�3 ., °J A`( F n ILCn V-R wt�µ ��e cQ •`i2 S k�
Name of Authorized Agent: E�)va2Du 54«a2-A44-
Address of Authorized Agent:
Phone Number of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed
above and I personally filled out the above information and certify its accuracy.
Signature of property owner Date: <<
Note: A copy of the property owner's driver's license, form notarization, or other
verification acceptable to the agency is required to be presented when the permit is issued
to verify the property owner's signature. For additional information see Section 19825 of
the Health and Safety Code.
1
�q of RI I,
o .n
gz County of Riverside
4 Department of Building and Safety
l�G• P4
end yA FCTY
NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as
the builder of the property improvements specified at
We are providing you with an Owner-Builder Acknowledgment and Information Verifica-
tion Form to make you aware of your responsibilities and possible risk you may incur
by having this permit issued in your name as the Owner-Builder. We will not issue a
building permit until you have read, initialed your understanding of each provision,
signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior
approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify
this information.
�_1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an
"Owner-Builder" building permit that erroneously implies that the property owner is providing his or her
own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious
financial risk for any injuries sustained by an unlicensed person and his or her employees while working
on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully
acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers
on my property.
ZK-2. 1 understand building permits are not required to be signed by property owners unless they are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
�3. 1 understand as an ""Owner-Builder" I am the responsible party of record on the permit. I under-
stand that I may protect myself from potential financial risk by hiring a licensed Contractor and having
the permit filed in his or her name instead of my own.
ihtir
4. 1 understand Contractors are required by law to be licensed and bonded in California and to list
license numbers on permits and contracts.
65. 1 understand if I employ or otherwise engage any persons, other than California licensed
ontractors, and the total value of my construction is at least five hundred dollars ($500), including labor
and materials, I may be considered an ""employer" under state and federal law.
1
I
1
6. 1 understand if I am considered an ""employer" under state and federal law, I must register with
the state and federal government, withhold payroll taxes, provide workers' compensation disability in-
surance, and contribute to unemployment compensation for each "employee." I also understand my
fail re to abide by these laws may subject me to serious financial risk.
7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds
single-family residential structures cannot legally build them with the intent to offer them for sale, unless
all work is performed by licensed subcontractors and the number of structures does not exceed four
within any calendar year, or all of the work is performed under contract with a licensed general building
Contractor.
�8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be
held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from
any latent construction defects in the workmanship or materials.
9. 1 understand I may obtain more information regarding my obligations as an ""employer"from the
ni ternal Revenue Service, the United States Small Business Administration, the California Department of
Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the
California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb,ca.gov
for re information about licensed contractors.
0. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and
for
that I am the party legally and financially responsible for proposed construction activity at the
following address:
i11. 1 agree that, as the party legally and financially responsible for this proposed construction
t—iVity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as
employers.
4 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to
any of the information I have provided on this form. Licensed contractors are regulated by laws designed
to protect the public. If you contract with someone who does not have a license, the Contractors' State
License Board may be unable to assist you with any financial loss you may sustain as a result of a
complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for
you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while
working on your property, you may beheld liable for damages. If you obtain a permit as Owner-Builder
and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are
properly licensed and the status of their workers' compensation insurance coverage. Before a building
permit can be issued, this form must be completed and signed by the property owner and returned to the
agency responsible for issuing the permit.
Note: A copy of the property owner's driver's license, form notarization, or other
verification acceptable to the agency is required to be presented when the permit is
sued to verify the property owner' ignature.
Signature of property owner Date: Ik rLl
Permit Number
2
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state of California,coumcy of,[jatr�lk
Subscribed and swor to(or affirmed)before'(fie
on lhfs dayy of }� ___0 r CANDICE NICCLE MCGOWAN
by U i(f 4 d h1 . IA/�rf a COMM.#2034260
proved to me on the basis of satisfactoly evidence NOTARY PUBLIC-CUIFORNML„
to be the person ,who
a gee.aarre�d�before me. RIVERSIDE COUNTY
U�, ICIl ll�Nl �ri My COMM.Ex auyz�..,M1Mor
signature
C��LI Pig
` tN NIADRIAGA
GN RICHARD MORT_ - -
29037 WAYFARER ROAD
r - SUN CITY,CA 92585
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