PMT15-03624 City of Menifee Permit No.: PMT15-03624
29714 HAUN RD. Type: Residential Addition
�ACCEL/> MENIFEE, CA 92586
MENIFEE Date Issued:
11/19/2015
PERMIT
Site Address: 30083 CALLE BELCANTO, MENIFEE, CA Parcel Number: 364-091-011
92584 Construction Cost: $2,000.00
Existing use: 1 &2 Family Residence Proposed use:
Description of 10 L FT GAS LINE TO RELOCATE EXISTING FIRE PIT
Work:
Owner Contractor
BEV&STEVE RANISZEWSKI CALIFORNIA POOLS INC
30083 CALLE BELCANTO 34 WATERWORKS WAY
MENIFEE,CA 92584 IRVINE, CA 92618
Applicant Phone:8002827665
PAIGE METZGER License Number: 185102
CALIFORNIA POOLS INC
34 WATERWORKS WAY
IRVINE, CA 92618
Fee Description gyt Amount 191
Plumbing Fixtures and Vents,fixtures 1 116.00
Building Permit Issuance 1 27.00
Additional Plan Review Plumbing 1 1.00
GREEN FEE 1 1.00
$145.00
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 ❑ lam exempt from licensure under the Contractors'State License Law for the
1 hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that,except for my personal residence ii
Professions Co license is in full force and effect Y which I must have resided for at least one year prior to completion a
License Class —Licens No. improvements covered by this permit, I cannot legally sell a structure that I haw
Expires 'LO 12 Signature built as an owner-building if it has not been constructed in its entirety by licensee
contractors. I understand that a copy of the applicable law, Section 7044 of thr
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application is
submitted or at the following Web site:
❑ I hereby affirm under penalty of perjury one of the following declarations: http./Avww leciinfo ce cov/calaw.htmi.
I have and will maintain a certificate of consent of self-insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by 2 />, Date �'`
Section 3700 of the Labor Code,for the performance of work for which this vo6 —
permit is issued. Pr perty Owner or Autho' dAgent
Policy# ❑ By my Signature below, I certify to each of the following: I am the propert
I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owners behalf. I have read thi:
3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct.ct. I agree to comp(
�on
permit Is issued.Myworkers'compensation insurance carder and policy number are: with all applicable city and county ordinances and state laws relating to buildini
��� construction.I authorize representatives of this city or county to enter the above
Carder Identified property for the inspection pu@uses. � f_
Policy# V� /�2 Expires 2 D I Date �( l
roperty Owner or harized Agent
(This section need not be completed if the permit is for
one-hundred dollars($100)or less) City Business License#
❑ 1 certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not emolov any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers'compensation laws of California, and agree that If I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide?
Code,I shall forthwith comply with those provisions. �I C DYES ❑NO
Applicant; ate; ' , ` ' I 1 Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNI FAI RE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES ❑NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES ❑NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health&Safety Code,Section 25505 and 25534 conceming
3097 Civil Code) hazardous material reporting.
OWNER BUILDER DECLARATIONS ❑NO /���(// �1 't
I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's ^ � \ Date L`
License Law for the reason(s)indicated below by the checkmark(s)I have placed P RTY PE OWNER OR AU RIZED AGENT
next to the applicable item(s)(Section 7031.5. Business and Professions Code: EPA RENOVATION-REPAIR AND PAINTING fRRPI
Any city or county that requires a permit to construct, alter, improve, demolish,
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 The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Provisions of the Contractor's Stale License Law(Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRPcertified firms and comply with
she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit
❑ I, as owner of the roe www.epa.govAead or contact the National Lead Information Center at
property rty, or my employees with wages as their sole 1-800-424-LEAD(5323).
compensation,will do( )all of or( ) porting of the work, and the structure is
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 ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
Who, through employees' or personal effort, builds or improves the property,
Provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name:
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 Firm Certification No.:
Purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044, Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
''Menifee
DATE - I5 PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL-dRESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION []ELECTRICAL []MECHANICAL
[]NEW ❑PLUMBING []RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Q.S ✓G /
PROJECTADORESS C ; N-- I ej
ASSESSOR'S PARCEL NUMBER ,'4,PL '- Oq I.CJ I LOT 11 TRACT d4a,{
OWNER NAME
V �_ Ii _ i S Ii_ pL I ,--;
ADDRESS
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PHONE `"I 5 -L ? 1 G 7J 3 EMAIL
APPLICANT NAME 61I(: C C
ADDRESS q 1 7j C' p Al77 1. 1� I t I rC t 15D
PHONE ��'�jU7 ?/�2� EMAIL
CONTRACTOR'S NAME II CZ ( S OWNERBUILDER? [-]YES ,
BUSINESS NAME /a. l 1 r l� I Il� Z� J I
ADDRESS (��(���I �- v 'j' C l.(/ - *jq
PHONE 3TI-7 EMAIL /� 2
CONTRACTOR'S STATE LIC NUMBER G,�7 J SS JD LICENSE CLASSIFICATION 1. 11 ;J
�
� U' Zaap
VALUATION$ f / SQ FT L SQ FT
APPLICANT'S SIGNATURE �,, i,I ,\ yI DATE I �I
L low-
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE 1 PAIDAMOUNT
AMOUNT OCASH OCHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee; CA 92586 951-672-6777
www.cityo fineni fee.us Inspection Request Line 951-246-6213
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