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PMT16-00797 City of Menifee Permit No.: PMT16-00797 29714 HAUN RD. Type: Pool/Spa-Residential S�CCELA MENIFEE, CA 92586 MENIFEE Date Issued: 0311812016 PERMIT Site Address: 25312 APACHE HILL CIR, MENIFEE, CA Parcel Number: 358461-016 92584 Construction Cost: $32,500.00 Existing Use: Proposed Use: Description of INGROUND POOL&SPA 457 SQ FT Work: Owner Contractor STEVE&TERESA EWING SUBIC BAY POOLS AND LANDSCAPES 5312 APACHE HILL CIR CONSTRUCTION MENIFEE, CA 92584 37139 HIGH VISTA DRIVE Applicant Phone:9513238417 EDUARDO SALAZAR License Number:889971 SUBIC BAY POOLS AND LANDSCAPES CONSTRUCTION 37139 HIGH VISTA DRIVE MURRIETA,CA 92563 Fee Description gyt Amount 281 Swimming PooUln-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 $524.35 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 property who builds or improves thereon,and who contracts for the projects I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law). 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 aa�n1d my license is in full force and effect. the following reason: License Class l: Lic( se No. By my signature below I acknowledge that,except for my personal residence Expires (' Signature S in which I must have resided for at least one year prior to completion of 1 / improvements covered by this permit.I cannot legally sell a structure that I WORKER'S COMP NSATION 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,leeinfo.ca.eov/calaw.html. this permit is issued. Policy q Date ❑1 have and will maintain workers 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 workers compensation insurance carrier and policy owner or authorized to act an the property owners behalf.I have read this number are: application and the information I have provided is correct I agree to comply Carrier G/ !/1 with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives ofthis city or county to Policy N Q Z Expires p enter the above identified property for inspection purposes. (This section need n.191 be completed is the permit is for one-hundred Date dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT ❑I certify that in the performance of the work for which this permit is issued, I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE fl workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 3700 of the Labor Code,I shall fortIfth comply with those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant - Dace (p mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide. WARNING:FAI RETO SECURE WORKER'S COMPENSATION VERAGE IS ❑Yes gFNo UNLAWFUL,A SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building AND CIVIL FINES UPTO 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)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines CONSTRUCTION LENDING AGENCY ❑Yes %YNo 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 ofthe work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) ❑Yes 4LNo OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of Contractors License Law for the reason(s)indicated below by the California Health al Safety Code,Section 25505 and 25534 concerning hazardous material reporting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 pDYes 16 / Business and Professions Code).Any city or county that requires a permit to Date (p construct,alter,Improve,demolish or repair any structure,prior to its PRO 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 Contractors State EPA RE VATION,REPAIR AND PAINTING IRRPI License Law(Chapter9(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 exempt from 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-certfied 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 their sole 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 Firm is required for this project because: ❑1,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors 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. BUILDING & SAFETY PERMIT/PLAN CHECK Ar r Y' ):� Y Menifee ' -J ii Admi DATE ( G PERMIT/PLAN CHECK NUMBER I'Q� TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME /BPOOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK S / PROJECTADDRESS S 'Z T Q ,l L( vgt% 2 ASSESSOR'S PARCEL NUMBER 619-Apo(-C) 10 LOT 55�1 TRACT OWNER NAME `e aj ADDRESS ��IZ tJ/I 2AdeAd( i ro� C e� CGT 9s, PHONE EMAIL APPLICANT NAME ADDRESS (6Gllt C� �Z S PHONE Cq�() f67--10 1 EMAIL CONTRACTOR'S NAME OWNER BUILDER? O YES •NO BUSINESS NAME tG !!// t& " GYN v ADDRESS `( (�+'G r✓ !' ✓ C PHONE EMAIL ^� CONTRACTOR'S STATE LIC NUMBER �JLICENSE CLASSIFICATION Z C S > VALUATION$ Z SQ FT 1 L SO FT APPLICANT'S SIGNATURE DATE CITYSTAFFUSEONLY DEPARTMENT DISTRIBUTION r�-�Xv1 CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I GREEN Oe SMIP v INVOICE I PAID AMOUNT r, AMOUNT OCASH 0CHECK# CREDITCARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# v'CREDITCARD VISA/MC OWNER BUILDER VERIFIED O YES 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.cityofinenifee.us Inspection Request Line 951-246-6213 3�►l�zo� City of Menifee Building & Safety Dept. 44/�X W NCZtN MAR 18 2016 Received A64-N A Or SU bj( W pCO,s � LA No s,�Op� (s Aui�tOR IZln1,0 UDUU�c�o stt�t7.�t� 70 �oL � Qt37�W A- ��IT Mn n�y ecr AT 2S31z 4PACµE H iCL Cf2cl�, McNI� CAZ f�lvic yc�u VtA. - MvC4 9 - /\OLIU �� Su $�G 3qy Pooh �� UGe-nee , l.nvns�,,�es rvo . 389q7l �a� C4 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 FA otary public or other officer completing this certificate verifies only the identity of the individual who signed the ument to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California ) County of — On 0-2 f ►G before me, S Date Here Insert Name and Title of the Officer personally appeared C-L rA - (VI . A-{-- 6 Nft Name(s) of Signers who proved to me on the basis of satisfactory evidence to be the person w ose name(sfis/a{� subscribed to a within instrument d acknowledged to he/on the instrumenexecutet he person, I(s)�- his/ham authorized capacity(i ,and that by his/herAne signature(. or the entity upon behalf of which the persons} acted, executed the instrument. �� I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS m hand and offiseal. Q : . y ris SAN70i AASs -c ? -•'- 1 com h•OtC .t_ 't Notaryp�o�c^2033 gd'tCcJ;S Signature My comN'versiUe co et/tornia Signature of Notary Public Iresit only a `gyp f0 2 i `�� Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Mw Description of Attached Document ( J vj'� L 7 Title or Type of Document: Number of Pages: Document Date: Signer(s) Other Than ed Above: Capacity(ies) aimed by Sig (s) Signe ' Name: Signer's Na e: ❑Corpora Officer — Title(s): ❑ rtner —te Offices — Titl0 G ❑ Partner — ❑ Limited ❑General Partner — ❑ Limit d ❑Gen al ❑ Individ al ❑Attorney in Fact ❑ Individual ❑A� rney ' Fact ❑Tn stee ❑Guardian-or Conservator_ ❑Trustee ❑Guar an or Conservatc ❑ Other -Other: Signer I Signe s Representing: s Representing: ©2015 National Notary Association -www.NationalNotary.org - 1-800-US NOTARY(1-800-B76-6827) Item '5907 0 { � 7 � Oa0 { Ile / q \ f « � f ƒ / o/ � E - 0 2 z « o n » ± n p gae k % ƒ / ) 7 0% ' � \ CD # r � ) /0 o£ 00 v (Ir - m < }k 7 mF / / _ n o@ a a § 3 / / ƒG 3i a ■ 3 Z # ƒ / � t »