PMT15-02027 I
City of Menifee Permit No.: PMT15-02027
29714 Type: Pool/Spa-Residential
'WCC�I..�` MENIFEE,EE, C CA 92 92586 I
MENIFEE Date Issued: 07/16/2015
�I
PERMIT
Site Address: 28629 WELLINGTON CT, MENIFEE, CA Parcel Number: 336-432-016
92584 Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of INGROUND GUNITE POOL AND SPA
Work:
i
Owner Contractor
PATRICIO JUAREZ QUALITY CUSTOM POOLS INC
28629 WELLINGTON COURT 30138 MARNE WAY
MENIFEE, CA 92584 MENIFEE, CA 92584
Applicant Phone: 9516799732
LYNN STONE License Number: 795820
QUALITY CUSTOM POOLS INC
30138 MARNE WAY
MENIFEE, CA 92584 -
Fee Description Amount
Building Permit Issuance 1 27.00
EE 0;
SMIP RESIDENTIAL 1 4.00
$499.00
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 building 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 61dg 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 m- license is in full force and effect:Y Code:The Contractor's License Law does not apply to anownerb-a-property ---
License Class S'_; _5 License No."1 G51 U who builds or improves thereon, and who contracts for the projects with a
Expires Signatures ------- .licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION D756A_ TION
❑ I am exempt from licensors 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
C T I 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:htto'//wvvw.leginfo.ca.gov/calaw.html.
permit is issued. My workers'compensation insurance carrier and policy number are:
Carrier Property Owner or Authorized Agent Date
Expires —7 Policy# (A ( b D 03 i CON)
�Y 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-
El I certify that in the performance of the work for which this permit is issued,I Identified property for the inspection purposes.
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 t
subject to the workers'compensation provisions of Section 3700 of the Labor Propeft�trr'Atnthor z_d gent Date
Code,I shall forthwith comply with those provisions.
City Business License#
Date; )b 15 Applicant;
WARNING: FAILURE TO — RE 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, 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 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 NZOO DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS
B
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the reasons)indicated below by the checkmark(s)I have placed DYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable ileri (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, ,[�N0 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 rp NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE SECTION
LJS ION MAT25505
AL5 25533,EPORI AND 25534 CONCERNING
El I, as owner of the property, or my employees with wages as their sole
compensation,will do ( )all of or ( )porting of the work, and the structure is PROPS W�-JWNER OR AUTHORIZED AGENT
not intended or offered for sale, (Section 7044,Business and Professions Code; L
The Contractor's State License Law does not apply to an owner of a property X
---
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale. If,however,
the building or improvement is sold within one year of completion, the Owner- ---_
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
PERMIT/PLANBUILDING & SAFETY A. • •
"Menifee
DATE `I - 1Q - 1 5 PERMIT/PLAN CHECK NUMBER 09
TYPE: 1 COMMERCIAL 0, RESIDENTIAL ::1 MULTI-FAMILY C' MOBILE HOME &POOL/SPA �:1 SIGN
SUBTYPE: 0 ADDITION 0 ALTERATION 0 DEMOLITION 0 ELECTRICAL r' MECHANICAL
0 NEW C PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK q,VyY I p b Ile )( y
i
rn� �
PROJECTADDRESS o�"I W el II I R YJ q
ASSESSOR'S PARCEL NUMBER b\lP LOT TRACT
RI p CI y o
OWNER NAME oA- Lk 01 Y' f-Z_ Building & Safety Dept.
ADDRESS 11 e I) I Vl C+ JUL 16 2015
PHONE q5 j '-1 -1 EMAIL
APPLICANT NAME Received
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME I vy1 4 OWNER BUILDER? (.'YES 00 NO
BUSINESS NAME yk, I L O 1 S '
ADDRESS fftt3 D 1 ne. � ' 1
PHONE C15 1 Le-� 01 DIrI S EMAIL
CONTRACTOR'S STATE LIC NUMBER ;I- LICENSE CLASSIFICATION
VALUATION$ 9-5 ,p U b SO FT y I oL L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF-MEN[F EE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP LA
INVOICE I PAID AMOUNT
AMOUNT �� 1 CI CASH C%CHECK# =:'CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT `.:" CASH O CHECK# CCREDITCARD VISA/MC
OWNER BUILDER VERIFIED AYES 0 NO DLNUMBER NOTARIZED LETTER 0 YES C/ NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
5'6"prro Lin nce operty e Fe
EL
City of Menifee W
12'7 spa Building & Safety Dept.
6"Deep 5 JUL 16 2015
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LL
Dee
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Dees Received
Existing
6'Blotk
Wall
m
5'6"
Property Property
Line
Fence
Juarez Residence
28629 Wellington Ct.
Menifee, Ca 92584
CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENT
PLAN APPROVAL
REVIEWED_By
Ilo
DATE
Driveway 'Approval of these plans shall not be construed to be a permit for,or an
approval of,any violation of any provisions of the federal,state or city
regulations and ordinances. This set of approved plans jobsite until completion. must be kept on the