PMT15-02181 City of Menifee Permit No.: PMT16-02181
y+�'�' ''•��,. 29714 HAUN RD. Type: Pool/Spa-Residential
C;KCCEL.l3 MENIFEE, CA 92586
MENIFEE Date Issued: 07/29/2016
PERMIT
Site Address: 27989 WHITTINGTON RD, MENIFEE, CA Parcel Number: 336-511-002
92584 Construction Cost: $35,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL ONLY
Work:
Owner Contractor
MARK MILLER QUALITY CUSTOM POOLS INC
27989 WHITTINGTON ROAD 30138 MARNE WAY
MENIFEE, CA 92584 MENIFEE, CA 92584
Applicant Phone: 9516799732
JIM BARRETT License Number: 795820
QUALITY CUSTOM POOLS INC
30138 MARNE WAY
MENIFEE, CA 92584
Fee Description ON Amount is
Building Permit Issuance 1 27.00
E:_ ZMENIMMA
SMIP RESIDENTIAL 11 5.00
$601.00
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 0"5 License No. nq�5. who builds or improves thereon, and who contracts for the projects with a
Expires I( / :a Signature/`-'' licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION D CLARATION
❑ 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
Xd 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:http,Uwww leoinfo ca covlcalaw html.
permit Is Issued.My workers'compensation insurance carrier and policy number are:
� Property Owner or Authorized Agent Date
Carrier
Expires/ j Lp Policy# C " gin I cif XL
❑ 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 buildl�
construction. I authorize representatives of this city or county to enter'"_ ,ove-
❑ I certify that in the performance of the work for which this permit is issued, I identified property for the Inspectlart puurrposes.
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 9
subject to the workers'compensation provisions of Section 3700 of the Labor Owner uth ize nt to
Code,I shall forthwith comply with those provisions. /�: "
_ ,-�� City Business License#
Date; Applicant;
WARNING: FAILURE O CURE -]®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, 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
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 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
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 reasons)indicated below by the checkmark(s)I have placed DYES 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 I HAVE READ THE HAZARDOUS MATERIAL
provisions of the Contractor's State License Law (Chapter 9 (commencing with
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($500).) CODE, SECTION 25505RIAL 25533 W AND 25534 CONCERNING
HAZARDOUS❑ I, as owner of the property, or my employees with wages as their sole
compensation,will do ( )all of or( )porting of the work, and the structure is PROPERTY OWNER OR AU THQ ED AGENT
not intended or offered for sale.(Section 7044, Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,provided that that the improvements are not intended or offered for sale. If,however,
the building or improvement Is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF MIL NIFEE PLCK No: Permit No:
29714 Haun Road Date: Date: `
Menifee, CA 92586
Phone: (951)672-6777 Amount Amount:
Fax:(951)679-3843 Ck#: Ck#:
• 8
Building Combination Permit Building &of Safety Dept.
To Be Completed By Applicant
Legal Description: Planning Case: F: L: Rt: R
Property Address:/ f—us1 Assessor's Parcel Number:
Project/Tenant Name: Unit#: Floor#:
Name: Sir Phone No. Fax No.
Property Address: - Unit Number Zip Code
Owner 7�
Email Address:
Name: �Ph
JI one No. Fax No.
� ld
Applicant Address: - Unit Number Zip Code
Email Address:
Name: Phoge N� �� Fax No ) l
V 11� 7 LO
Contractor Address; City State Zip Code
cf�
Contractors City Business icense No. C tractors City State of California License o. Classification:
Number of Squares:
Square Footage J
Description of Work: Cost of Work:$
Applicant's Signatu Date: r-
To Be Completed By City 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 ❑ Gee Tech/Soils Report(on cot only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8%x 11)
❑- Structural Calculations
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration` Addition' MeanslMethods
Work Type:El Repair" Retrofit* Revision to Existing Permil' 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 Sprinklered that apply: Coastal Zone
Construction
Completion: Type(s): C of Cad YES or NO Noise Zone
Requir ? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm-Zoning Administrator
Fee Exempt: City Pro ect Elec.Vehicle Charger Landmark Seismic Retrofit Spec+al Case:61dg.
p y J g OlrioalA oval
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Building/Safely I Permit Specialist I City Planning ICivil Engineering EPWM-Admin Transportation Mgmt. Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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