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PMT16-00514 City of Menifee Permit No.: PMT16-00514 29714 HAUN RD. Type: Pool/Spa-Residential <A-CCEL/? MENIFEE,CA 92586 " 1tSIO.- MENIFEE Date Issued: 0 212 9/2 01 6 PERMIT Site Address: 29434 WILDCAT CANYON RD, MENIFEE, Parcel Number: 351-250-008 CA 92587 Construction Cost $30,000.00 Existing Use: Proposed Use: Description of NEW INGROUND SWIMMING POOL&SPA 389 SQ FT Work: Owner Contractor TIM DOMICCIO BLUE FOUNTAIN POOLS AND SPAS INC 29434 WILDCAT CANYON RD 221 W F STREET MENIFEE, CA 92587 ONTARIO, CA 91762 Applicant Phone:9099837665 IVAN ARIAS License Number. 1004554 BLUE FOUNTAIN POOLS AND SPAS INC 221 W F STREET ONTARIO, CA 91762 Fee Description Qtv Amount($) 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 building 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 property who builds or improves thereon,and who contracts for the projects With a licensed contractor(s)pursuant to the Contractors State Umnse Law). I hereby affirm under penally of perjury that I am under provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law for Professions code and my license is in full force and effect. the following reason: License(lass_ Lice se No. L By my signature below I acknowledge that,except for my personal residence i Expires '�jo—t/�' Signature in which I must have resided for at lease 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 of the 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 worker's 7044 of the 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 of the Labor Code,for the performance of work for which www.Ieginfo.ca.iRov/caIaw.htmL permit is issued. m.e0v/calaw.html. Policy If Date - ❑1 have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I certify to each of the following:I am the property this permit is issued.My worker's compensation insurance carder and policy owner or authorized to act on the property owner's behalf.I have read this number are: application and the information I have provided is correct.I agree to comply carrier �✓elCC94U✓1�af�Ce CbH1a�l 1'7L•i with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy sWWC3�y�J;G2—Expires '3 �(e 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 a certify that in the performance of the work for which this permit is issued, 1 shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE p worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the worker's compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant :"All mixture Date mixture containing a hazardous material equal to or greater that the Ar amounts sp�°cified on the Hazardous Materials Information Guide. WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 6 ❑Yes 7No UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the 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 ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)7See permitting checklist IN SECT10N 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guideli s CONSTRUCTION LENDING AGENCY ❑Yes 110 I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the lending agency for the performance of the work which this permit is issued outer botyfdary of a school? (Section 3097 Civil Code) ❑Yes N.0 OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that 1 am exempt from the permitting checklist.I understand my requirements under the State of Contractor's License Law for the reason(s)indicated below by the Cazardou Bate al Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Dyes ou material reporting. Business and Professions Code).Any city or county that requires a permit to Dyes No s �rni � ��Y4W Date 2—2 4 4, 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 of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRPj License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors Business and Professions Code)or that he or she is exemptfrom 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 Applicant for 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 ❑I,as owner of the property,or my employee with wages as theirsole employees.For more information about EPA's Renovation Program visit: compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.eov/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 of a ❑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 Finn is required for this project bemuse: ❑I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill Out the RRP Acknowledgement. i BUILDING iSAFETY PERM IT/PLAN • • • Menifee DATE PERMIT/PLAN CHECK NUMBER N ' E TYPE: 0 COMMERCIAL Y RESIDENTIAL v MULTI-FAMILY MOBILE HOME POOL/SPA 0 SIGN SUBTYPE: 0 ADDITION 0 ALTERATION < DEMOLITION 0 ELECTRICAL MECHANICAL 0 NEW " PLUMBING RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK VoDL S PROJECT ADDRESS Q ASSESSOR'S PARCEL NUMBER J' � �� LOT 0�j TRACTO OWNER NAME ('A 1 ADDRESS 2C G PHONE asl- Kqo- 912 1 1 EMAIL APPLICANT NAME j-kq S ADDRESS 2jj, j Y PHONE Cd EMAIL CONTRACTOR'S NAME _J�jUv, OWNER BUILDER? 0 YES NO BUSINESS NAME iv1 OQ 5 ADDRESS L,) l PHONE IM- Cl 1;�_5- L 6 6 h EMAIL CONTRACTOR'S STATE LIC NUMBER ( DO�h h LICENSE CLASSIFICATION c -6 3 VALUATION$ SO FT L SO OFT APPLICANT'S SIGNATURE DATE !� DEPARTMENT DISTRIBUTION p CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINES NG FIRE GREEN SMIP 40 INVOICE �/f� ,151 PAID AMOUNT AMOUNT !• ^ CASH %CHECK# <:CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT O CASH r%CHECK# ? CREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES C) NO DL NUMBER NOTARIZED LETTER : YES O NO City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityo(rneni(ee.us Inspection Request Line951-246-6213 ZI`�,. ZpcSSE D '1' pSA \y Q�a,�SrQ. SQL v � giZ 5 z 1$ • � giZ 17`I2- 4S�oX� 1471 i , go . ��aaF•