PMT14-02528 City of Menifee Permit No.: PMT14-02628
29714 HAUN RD. Type: Pool/Spa-Residential
MENIFEE, CA 92586
MENIFEE Date Issued: 09/19/2014
PERMIT
Site Address: 28394 TUPELO RD, MENIFEE, CA 92584 Parcel Number: 372490-008
Construction Cost: $40,000.00
Existing Use: Proposed Use:
Description of IN GROUND POOL 485 SO FT& 15 L FT GAS LINE FO R FIREPIT/BBQ
Work:
Owner Contractor
WAYNE EWING QUALITY CUSTOM POOLS OF RIVERSIDE INC
28394 TUPELO RD 11361 DEER GLEN RD
MENIFEE, CA 92584 YUCAIPA, CA 92399
Applicant Phone: 9097909601
MIKE&TERRIE WALKER License Number: 825138
QUALITY CUSTOM POOLS OF RIVERSIDE INC
11361 DEER GLEN RD
YUCAIPA, CA 92399
Fee Description -
City Amount I$1
wl min .R I/In-Ground*spa oy U
BUlldln' Permit Issuance 1 27.00 -
s
GREEN FEE 1 2.00
$618.00
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 issua
nce,or where thew wo
rk k commenced is suspended or abandoned for six months shall
P expire,and fees paid
forfeited. � P � p d shall be
Medg_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 C53 Licen 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:
e 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
❑ 1 have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http,/AAtww.leoinfo.ca.gov/calaw.htmi.
permit is issued.My workers'compensation insurance carver and policy number are:
Property Owner or Authorized Agent Date
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 t e information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicabl city and county ordinances and state laws relating to building
cons
tru ion. I a orize representatives of this city or county to enter the above-
certify that in the performance of the work for which this permit is issued,I idenfife prope for the inspection purposes.
all not employ any persons In any manner so as to become subject to the
workers'compensation laws of California, an agree that if I should become
subject to the workers'compensation provisio s of Sec 3700 of the Labor Property Owner or Authorized Agent Date
Code,I shall forthwith comply with those provi ons.
q City Business License#
Date; —j / ' 1 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, lo/ES 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 t3YIES 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 penally 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 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, z<O 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 INFORMATION GUIDE AND THE SCAQMD PERMITTING
Section 7000)of Division 3 of the Business and Professions Code)or that he or g
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 ST TE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) HAOZDARDO STMA RIAL51'<EPOR�INGD 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole
compensation, will do ( )all of or( )porting of the work, and the structure is PROPER 0 N OR AUTHORIZED AGENT
not Intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY '{,,l' 1V' ENIFIEE PLCK No: P It o:
!�'Tt� S
29714 Haun Road Date: Date:
Menifee, CA 92586 40,1 1A
Phone: (951)672-6777 Amount: Amount: 1 COD
Ck#: Ck#:f\L—J
Building Combination Permit a SG
To Be Completed By Applicant
Legal Description: a6r'1vY_� Planning Case: F: L: Rt: R
Property Address: ^'CC Assessor's Parcel Number:
�Zo 1 at - yq0-cm
ProjecUTenant Name Unit#: Floor#:
�\
Na P U0 q3 PS I�Z Fax No.
Property Addre Unit Number
Zi Code 1
Owner It 'I
Email Address:
' S-;l-' Z(oV
Nam Phone No. Fax No.
Applicant Add res3 Unit Number ZipO od
CL
Email Address: C` n 11
Name:I` IJ _� Phone No
Contractor 7ddress 1 Ci State Zip Cotle
113 =- - 21 �a C(1 z 399
ontractor's ity usmess License o. Contrractor's City State of California LicenSd No. Classification
Number of Squares: Off.
Square Footage U
�l
Description of Work: ' Cost of1Wor`$
Applicant's Signature
Date:
To Be Completed By CClty Staff Only
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 cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8%x 11)
❑ ❑ Cross Section El Structural Calculations
Foundation Plan
❑ 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: Ceastel Zone
Completion: Type(s): Colo Noise Zone
quired Re ? YES or NO
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 sp.aal Cass,Bldg.
OmcialA royal
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Building/Safely Permit Specialist City Planning I Civil Engineering I EPWM-Armin I Transportation Mgmt IRent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY