PMT15-02088 a
City Of Menifee Permit No.: PMT16-02088
29714 HAUN RD.
4 C 1511- MENIFEE, CA 92586 Type: Pool/Spa-Residential
1
MENIFEE Date Issued: 0712212015
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PERMIT j
Site Address: 29395 ESCALANTE RD, MENIFEE, CA Parcel Number: 351-250-031
92587 Construction Cost: $20,000.00
Existing Use: Proposed Use:
Description of INGROUND 365 SQ FT SWIMMING POOL&SPA
Work:
Owner Contractor
WILLIAM&MICHELLE FLORES CARSON CUSTOM POOLS SPAS& LANDSCAPE - -
29395 ESCALANTE RD INC
MENIFEE, CA 92587 1809 SO EXCISE AVE ST 202
Applicant Phone: 9093211400
DERIO DIVINCENZO License Number: 430551
CARSON CUSTOM POOLS SPAS& LANDSCAPE INC
1809 SO EXCISE AVE ST 202
ONTARIO, CA 91761 -
Fee Description 0tyt Amount
Building Permit Issuance 1 27.00
SMIP RESIDENTIAL 1 3.00
$498.00
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_Templale.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 ��,a///s///s" �—✓ License N �J / who builds or improves thereon, and who contracts for the projects with a
Expires�QJS Signature licensed contractors)pursuant to the Contractors State License Law).
WORKERS'COMPENSATI EC ARATION
❑ 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
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 the folio site:htt ://www.le info.ca.cov/calaw.html. -
permit Is issued. My workers'cyoommpensation insurance carrier and policy number are: -7 2-
Carrier / f— ✓l, I I Propert 0 ror Agent- Daf
Expires 'I Policy#(8 ?7 7d l — (��
❑ 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 stale 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 identified property for the map c on purposes.
shall not emll any persons in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers'compensation provisions of Section 3700 of the Labor prop er ent D to
Code, I shall forthwith comply with those provisions. /
Date; � 7� Applicant; 1 City Business License#
WARNING: FAILURE TO SE RE RKERS' 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 OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES cCl'NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY /4 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 AYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address /111NO 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 forthe reasons)indicated below by the checkmark(s)I have placed DYES 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, p_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 to110
o UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than ($500).) CODE SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZAdDOUS MATERIAL F}EPORTING
compensation, will do ( ) all of or( ) porting of the work, and the structure is PROPERTY ER OR D AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
^i,y of Menifee '`'t
E,iilding & Safety Dept, ' Menefee
DATE PERMIT/PLAN CHECK NUMBER '15-�aQg p
TYPE: O C f@ SIDENTIAL C MULTI-FAMILY C; MOBILE HOME • POOL/SPA O SIGN
SUBTYPE: C:ADDITION 0,ALTERATION O DEMOLITION G ELECTRICAL O MECHANICAL
O NEW " PLUMBING % RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK SW twtwtt /S Pao ^a A- 3 f�5 Fti- 10,I�
PROJECTADDRESS aj3j1,9
if gddA.JTE #� 11 6.1At " C�a( 9.2S$
ASSESSOR'S PARCEL NUMBER 'Jj - A9�0- 0;!I LOT �U TRACT
OWNERNAME (fit (, IA e(k. lorc.S
ADDRESS 2931T 5Cc gt.1TE RO. t ( CA 9 3'a
PHONE 9s/- 399`• 9/3.2 EMAIL
APPLICANTNAME / In1LE Za
ADDRESS 1gol $f- A VC TAR i o 7
PHONE 96� •&jt- 1400 EMAIL tVIi7CCiI P $,
CONTRACTOR'S NAME �nn 5 OWNER BUILDER? 0 YES f NO
BUSINESSNAME E" Pb,C,LS 5
ADDRESS S. E G 15C- IVC CA WIQ
PHONE 509 ' 3,21. Jg0f) EMAIL n
CONTRACTOR'S STATE LIC NUMBER �30551 LICENSE CLASSIFICATION C- 5-3 C- 27
VALUATION$ 5Q L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION I /0 CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 6 SMIP /•/'V�
INVOICE PAID AMOUNT
AMOUNT C=CASH C:CHECKN OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT CASH >CHECKn .?CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED Ci YES :' NO DL NUMBER NOTARIZED LETTER C% YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-5213
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