PMT16-00172 City of Menifee Permit No.: PMT16-00172
29714 HAUN RD.
< -1CCELA> MENIFEE,CA 92586 Type: Pool/Spa-Residential
MENIFEE Date Issued: 01/21/2016
PERMIT
Site Address: 25357 RIDGEMOOR RD, MENIFEE, CA Parcel Number: 339-470-004
92586 Construction Cost: $32,000.00
Existing Use: Proposed Use:
Description of INGROUND GUNITE POOL ONLY
Work:
Owner Contractor
LUIS ALVAREZ CAL/PACIFIC POOLS&SPAS INC
25357 RIDGEMOOR ROAD 17130 VAN BUREN BLVD STE 47
MENIFEE,CA 92586 RIVERSIDE, CA 92504
Applicant Phone:9517762002
GARY SOPER License Number:652876
CAL/PACIFIC POOLS&SPAS INC
17130 VAN BUREN BLVD STE 47
RIVERSIDE, CA 92504
Fee Description OOtf Amount fSl
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 5.00
General Plan Maintenance Fee-Electrical 1 23.35
$624.35
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 Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'State License Law for the
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 in
Professions Code and my license is in full force and effect. �1 which I must have resided for at least one year prior to completion of
License Class Licen 7G improvements covered by this permit, I cannot legally sell a structure that I have
Expires g^3(^/ 7 Signature built as an owner-building if it has not been constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law,Section 7044 of the
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: htto:I/www.leainfo.ca.aov/calaw.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# ❑ By my Signature below, I certify to each of the following: I am the property
1C I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owners behalf. I have read this
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 comply
permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and slate laws relating to building
construction.I authorize representatives of this city or county to enter the above-
Carder �C tl f identified property for the inspection purposes.
Policy# rSwc /s7.3 e3)— Expires y,L Dale
Property Owner orAuthor¢ed Agent
(This section need not be completed If the permit Is for City Business License#
one-hundred dollars($100)or less)
❑ 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 gignee that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensatiorjprovi ns o ection 3700 of the Labor amounts specified on the Hazardous Materials Information Guide?
Code,I shall forthwith comply with thou n isions. DYES WO
Applicant; Date; 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: F ILURE TO S WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION CO ERAGN NLAWFUL, AND SHALL for guide�'7p-�—s
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND ❑yE5 ❑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 o school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES
CONSTRUCTION LENDING AGENCY 1 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 uncle and-my7eq irements under the State of
agency for the performance of the work which this permit is issued (Section California Health& Code,Section 5505 and 25534 concerning
3097 Civil Code) �h�rdous al porting.
OWNER BUILDER DECLARATIONS \Y S NO /,2 j 1/
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date b
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPER OWNER OR A HORIZED 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 REN V TION REPAI AND PAINTING RRP
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 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 EPKs Renovation Program visit
www.epa.gov/lead or contact the National Lead Information Center at
❑ 1, as owner of the property, 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 Stale 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 properly,
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).
❑ 1, 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 Contractors 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
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
'Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME P POOL/SPA SIGN
SUBTYPE: 0 ADDITION CI ALTERATION O DEMOLITION Q ELECTRICAL 0 MECHANICAL
EYNEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER Y76 - o o v LOT TRACT kS't36'�
City Df Menifee
OWNER NAME G(/ •�L }� duilding & Safety
ADDRESS }ofJf? p
PHONE 5' S I ^Cc 7 9 ^ �! 30 EMAIL ,,q
APPLICANT NAME / �
OD♦ S ^' T/d� �'�'e veLA
ADDRESS 03. Y 02& ���J`
PHONE 5/ S f - r^� 76- )-bo L EMAIL llc/ le t. e- �`<I/`l�/U -rdG
CONTRACTOR'S NAME D OWNER BUILDER? G YES N
BUSINESS NAME //9c//Csi Od,.c t 7j
ADDRESS cr,� Fv 4v/O F �C / /lr/�"" �L r
PHONE nj.r/ �777& --ICDD 2 EMAIL
CONTRACTOR'S STATE LIC NUMBER r0//Sw 74 LICENSE CLASSIFICATION CS
VALUATION $ 3 Z 16b SO FT L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION ^^ C CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP S
INVOICE %4 .35 PAID AMOUNT =4 5
AMOUNT —1 J O'CASH O'CHECK# <%CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH •`%CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofineni(ee.us Inspection Request Line 951-246-6213
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