PMT15-03865 City of Menifee Permit No.: PMT15-03865
29714 HAUN RD.
�l-�CCEII-Ar MENIFEE,CA 9258E Type: Pool/Spa-Residential
MENIFEE Date Issued: 12117/2015
PERMIT
Site Address: 25954 PUEBLO CT, MENIFEE, CA 92584 Parcel Number: 358512-029
Construction Cost: $30,673.00
Existing Use: Proposed Use:
Description of INGROUND POOL AND SPA
Work:
Owner Contractor
JOSE SALAZAR&VERONICA QUINONES PAUL BOGNER POOLS
25954 PUEBLO COURT 5045 VAN BUREN BLVD
MENIFEE,CA 92584 RIVERSIDE, CA 92503
Applicant Phone:9516885543
MIKE LANSING License Number: 275843
PAUL BOGNER POOLS
5045 VAN BUREN BLVD
RIVERSIDE, CA 92503
Fee Description Oft f Amount ISI
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 4.00
General Plan Maintenance Fee-Electrical 1 23.35
$523.35
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_Pennit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'State License Law forth,
I 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 it
Professions Cod and my license is in full force and eff at which I must have resided for at least one year prior to completion c
License Class `, LicenNa. .5 improvements covered by this permit, I cannot legally sell a structure that I haw
-ce built as an owner-building if it has not been constructed In its entirety by licenses
Expires — Signature contractors. I understand that a copy of the applicable law,Section 7044 of IN
WORKERS'COMPENSATION DECLARATION Business and Professions Code,Is available upon request when this application is
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: htfo:llwww.leainfo.ca.cov/plaw.html.
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 Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy# rBy 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:
section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct I agree to compl.
permit is issued.My workers'compensation insurance carder and policy number are: with all applicable city and county ordinances and state laws relating to buildiry
�/ construction.I authorize representatives of this city or county to enter the above
Cartier 1�� idenfified pro a for the' pection purposes.
Policy#�/��9 O.�c.//f�Expires Y/�l��¢ Date
Property Ownerar Authorized A ent
(This section need not be completed if the permit is for City Business License#
one-hundred dollars($100)or less) 6d
❑ 1 certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ 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. DYES ❑NO
I �Applicant; Date;�r�- `1.3 �-5 Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNING: FAILURE 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 [I YES ❑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 concerning
3097 Civil Code) hazardous material reporting.
OWNER BUILDER DECLARATIONS DYES ❑NO
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5. Business and Professions Code:
Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION,REPAIR AND PAINTING IRRPI
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 State 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 RRP-certified firths 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 EPKs Renovation Program visit:
❑ www.epa.gov/lead or contact the National Lead Information Center at
I, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(6323).
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 Finn 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.
CITY OF MIUNAA'EE PLCK No: Permit No:
29714 Haun Road City of Menifee L95
Bullding & Safety Dept. Date: Date:
Menifee,.CA 92586
Phone: (951)672-6777 DEC 17 7015 Amount: Amount:
Fax: 951 679-3843 3-�
( ) Ck#: Ck#:
eoeived
Building Combination Permit
To Be Completed ByApplicant
Legal Description:-T:a {Lad-km4c.. Poo L * SPQ, Planning Case: F: L: Rt: R:
Property Addre Assessor's Parcel Number.
5c1 s_'�uebl (2 (YV_n i�_cc, at 25� 358 -5I2, -0243
ProjectlTenant Name: -
Jose Sc laZa1 .F�2roY� c� u Ino ue Unit#: Floor#:
Name: C _ ' PP1,one No. Fax No.
Property DSe. �C�tQZ.�l..r v'P�d`n 1 d'ne `151 - :>,4q- t-118 3
Owner Address:S,4 .Pueb10 umber- M- - ��<✓ ZS�S Unit N Zip Code g25gy
Email Address:- I KrAI
me: Phone No.
and Bo Poe)Is' -MI,VLe LzAnSern CtS LAB Ss 5543 FIVE•Le82s -7 3
Applicant Address: Unit Number Zip Code
Soy s �r� n l3 wren Q l v� _ �( v�us i Ck 01 2s o 3
Email Address:
7
me:
Cat l.1 (�` PO 1 /S� (� Pg
Cont honl �8 554 3
Contractor Aid s�
Contractor's CiOty Business License No. Contrail Ciiy State of California License No. Classification:
C_
Number of Squares: L4 10r.-�.,
Square Footage I O bN.
Description of Work: �,• `�IYVr�`� L vn At
pot)
� Cost of Work:$� 6-73
Applicant's Signature—Yv L7 1�
Completed By.City Staff Oniy
ndicate As R-Received orN/A-Not Applicable
5 Completes sets of fully dimensioned,drawn to sale plans which include: 1 set of documents which include
❑ Titie Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ 118e 24 Energy(on 8'/x 11)
❑ Foundation Plan ❑ Cross Section ❑ Structural Calculations
❑ Plumbing Plan ❑ Single Line diagram for elec.services over400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration- Addition' Means/Methods
Work Type: Repair' Retrofit` Revision to Existing Permir 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 Construction Spdnklered that apply: Coastal Zone
Completion:
Type(s): C Of O YES or NO Noise Zone
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit I Special Case:91dg.
Official Approval
Expedite Prcject(s): Child Care I City Project Green Building I 11-andmarkIAffordable Housing
For Staff Use Only
Building/safety Building/safety Permit Specialist I City Planning I Civil Engineering EPWM-Admin I TanspoRation Mgml. I Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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BUILDING AND SAFETY
PI AN AFIF OVAL
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EXISTING
CONCRETE 'App al of the plans shall not be col
approj ilotapy, ation of any provisic
regul I ons and c Anances. This set of<
jobsit untilcom letion.
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RESIDENCE
EXISTING
CONCRETE