PMT15-02715 City of Menifee Permit No.: PMT15-02715
_ 29714 HAUN RD. Type: Pool/Spa-Commercial
't-ICCELh? MENIFEE, CA 92586
"'m rssMmxn MENIFEE Date Issued:
10/18/2016
PERMIT
Site Address: 29737 ANTELOPE RD, MENIFEE, CA Parcel Number: 340-020-064
92584 Construction Cost: $140,000.00
Existing Use: Proposed Use:
Description of INGROUND GUNITE POOL 1683 SQ FT
Work:
Owner Contractor
FITNESS INTERNATIONAL LLC MISSION POOLS OF ESCONDIDO
3161 MICHELSON DRIVE 755 WEST GRAND AVENUE
SUITE 600 ESCONDIDO,CA 92025
Applicant Phone:7607432605
DAVE DRAPER License Number. 326760
MISSION POOLS OF ESCONDIDO
755 WEST GRAND AVENUE
ESCONDIDO, CA 92025
Phone: 9512963939
Fee Description QtV Amount IS1
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
Additional Plan Review Building 525 525.00
GREEN FEE 1 6.00
SMIP COMMERCIAL 1 40.00
General Plan Maintenance Fee-Electrical 1 23.35
$1,088.35
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 property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjurythat 1 am under provisions of with a licensed contmctor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 70001 of Division 3 ofthe Business and o I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. ! the following reason:
License Class L 53 Lice se No.7 T" C b By my signature below I acknowledge that,except for my personal residence
Expires i L Z / / Signature �' ./V in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
❑I hereby affirm under penalty of perjury one ofthe following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for workers 7044 ofthe Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website:
by Section 3700 ofthe Labor Code,for the performance ofwork for which w,,.rw.leeinfo.ca.eov/calaw.html.
this permit is Issued.
Policy# Date
o I have and will maintain workers compensation insurance,as required by
PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 ofthe Labor Code,for the performance ofthe work for which ❑By my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.1 have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier — `�� ' "tih' with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#CA JDavo 3 11 G / Expires 1Y & enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that In the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worke s compensation provisions of5ection 3700 ofthe Labor
Code,I shall fortl It comply �thj/those revisions. J 77 Will the applicant or future building occupant handle hazardous material era
Applicant :.. V Date /�£ h&')6 mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECUREWORKER'S COMPENSATION COVER/AGE IS o Yes o No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use ofthe building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
SECTION 3706 OF THE LABOR CODE,INTEREST,AND A DITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)7 See permitting checklist
N SOTTORNEYS FEES forguidelines
IN SEC
CONSTRUCTION LENDING AGENCY oYes allo
I hereby affirm that underthe penalty of perjurythere is a construction Will the proposed building or modified facility be within 1000 feet ofthe
lending agency for the performance ofthe work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) ayes n No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes a No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions ofthe Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicantfor a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). _ managers who do the paint-disturbing work themselves or through their
n I,as owner ofthe property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion ofthe work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner ofa o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or Improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm Is required for this project because:
o I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
APPLICATION
-'Menifee
DATE ,F—V'F I PERMIT/PLAN CHECK NUMBER 5
TYPE: MCOMMERCIAL []RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME POOL/SFA- []A Me fee
SUBTYPE: []ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICRLIding 8, Saf y Dept.
NEW []PLUMBING ❑RE-ROOF-NUMBEROFSQUARES SEP 0 015
DESCRIPTION OF WORK SWt 1-4 ty . II-A6 VI%OL Received
PROJECTADDRESS T — 1 f-Glf
ASSESSOR'S PARCEL NUMBER 3XA0 -0QQ' ( ka4 LOT TRACT /
PROPERTY OWNER'S NAME r7i T IJ 125 I P T'f T-pP.4 L, / I--L
ADDRESS/ 6 1 1 C-I`I F L,S alJ D A, S*rF O G�17 �ILvI J I�Z
PHONE /� L44l 'LS'1 "7 L.t O EMAIL r7
i
APPLICANTNAME l S SIOTIS Um1,E — b"vW- OVZA W1
ADDRESS S-7 L't>9 fSJS Y1 1< GT
PHONE (2s`(� -7-10 ' C:,I )I., EMAIL b&VEo Er-11SSJ�p�i�w6Sl C,a
CONTRACiOR'SNAME I J (-zIJ -DDCLS OWNERBUILDER? ❑YESZNO
BUSINESS NAME I_SS1e1J_ cb
ADDRESS -LDLf-4cL f;0,577k G7-'
PHONE(-S)� Z9 6 9 39 EMAIL VAQveb a H /jj b/Jph-)ij
CONTRACTOR'SSTATE LIC NUMBER ,3 L(-','1�n0 LICENSE CLASSIFICATION c—S 3
VALUATION$ —i-4J (d SOFT 1- 4 6 L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT O CASH O CHECK# O CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER O YES +% NO
City of Menifee Building & Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityo(meni(ee.us Inspection Request Line 951-246-6213