PMT16-00229 City of Menifee Permit No.: PMT16-00229
29714 HAUN RD.
'1►CCEL/� MENIFEE,CA 92586 Type: Pool/Spa-Residential
MENIFEE Date Issued:
01/27/2016
PERMIT
Site Address: 30652 BUCKBOARD LN, MENIFEE, CA Parcel Number: 35BA50-015
92584 Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA 361 SO FT
Work:
Owner Contractor
ED TIBAYAN MAJESTIC POOL CONSTRUCTION
30652 BUCKBOARD LN 31566 RAILROAD CANYON ROAD
MENIFEE, CA 92584 STE 2#106
Applicant Phone:9514456384
OBIE RODRIGUEZ License Number: 889638
MAJESTIC POOL CONSTRUCTION
31566 RAILROAD CANYON ROAD
STE 2#106
CANYON LAKE, CA 92587
Fee Description Qtv Amount f6)
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 4.00
General Plan Maintenance Fee-Electrical 1 23.35
$522.36
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 building operations being carded 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 Pennil_Templatexpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ I am exempt from Ilcensure under the Contractors'State License Law for the
following reason:
I hereby affirm under penalty or perjury that I am licensed under provisions of
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 �y license is in full force and effect. which I must have resided for at least one year prior to completion of
License Class CC%%SS License
,,No.
/� ����3 IF improvements covered by this permit, I cannot legally sell a structure that I have
Expires /— /'-7 Signature CX�—zo- r 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://www.leainfo.ca.00vlcalaw.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
❑ 1 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.Myworkers'compensation insurance carer 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-
Carrier identified property for the inspection purposes.
Policy# Expires Date
Property Owner or Authorized Agent
(This section need not be completed if the permit is for )�7
City Business License#
one-hundred dollars($100)or less) �{{{
HAZARDOUS MATERIAL DECLARATION
I certify that in the performance of the work for which this permit is issued,I
Xs 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 amounts7�pecified on the Hazardous Materials Information Guide?
Code,I shall forthwith com�plyyyww)iitth those provisions. ❑YES j1J NO
Applicant };Cate; 1 — Z7 —14 Will the/Intended use of the building by the applicant or future building
(f 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 guideli as
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OYES NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the roposed 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 ❑YESNO
CONSTRUCTION LENDING AGENCY I havered the Hazardous Material Information Guide and the SCAQMD
1 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) ,h,,,aazardous material reporting.
OWNER BUILDER DECLARATIONS y�YES ❑NO
I hereby affirm under penalty of perjury that I am exempt from the Contractor's r 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(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 Iicensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and properly
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 theproperty, or m era to employees with wages as their sole �'epa.gov/lead or contact the National Lead Information Center at
Y P Y 9 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 Finn 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 l
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 fit art RM',
Acknowledgement �:�-.LL
& SAFETY PERMIT/PLAN CHECK APPLICATION
A-h. en.- ee
DATE 6 PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL X RESIDENTIAL•' O MULTI-FAMILY O MOBILE HOME O POOL/SPA OSIGN
SUBTYPE: OADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK O C2 C 24- SPI4
PROJECTADDRESS d SOS.2J DZ 57 S `Gr(G��d/ictg .�,q 2
ASSESSOR'S PARCEL NUMBER - -O I�.OT pI� TRACT :2-A `I-J
OWNER NAME L �
ADDRESS 3 D 6, S'v p ✓G/C� C7 �
PHONE �r1 - Z�1i / 6 �� EMAIL
APPLICANT NAME
ADDRESS 3 15-tio & UnJ / S'vlrE L /O.�
PHONE 9lrl 7�� �.i�7 EMAIL 4 CJ1�C d1404J4-Oc4 0✓7?:-do yLr-k7
CONTRACTOR'S NAME OWNER BUILDER? O YES NO
BUSINESS NAME ,4- O—
ADDRESS p31f6G � G/klf/-.O �/,1/ Z 6
PHONE / 57 - elIf 6.3�'Y EMAIL
CONTRACTOR'S STATE LIC NUMBER 6.i or- LICENSE CLASSIFICATION C�3
VALUATION$ Z.5 O P96 SO FT 36 L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION I� fo CITY OF MENIFEy'BySJNF$$LICENSE BER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP U-//Tl/
INVOICE 7j PAID AMOUNT
AMOUNT OCASH 0 CHECK N u'CREDITCARD VISA/MC
PLANCHECKFEES PAID AMOUNT TCCASH O CHECK It 0 CREDIT CARD VISA/MC
OWNER BUILDERVERIFIED O YES C NO DL NUMBER NOTARIZED LETTER 0- YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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