PMT16-00840 City of Menifee Permit No.: PMT16-00840
29714 HAUN RD.
�CCELA? MENIFEE,CA 92586 Type: Pool/Spa-Residential
.114 k.— MENIFEE Date Issued:
03/22/2016
PERMIT
Site Address: 28488 BOARDWALK CT, MENIFEE, CA Parcel Number: 333-570-019
92.585 Construction Cost: $55,200.00
Existing Use: Proposed Use:
Description of INGROUND POOL AND SPA,75' U/G GAS AND 75'U/G ELECTRIC LINE FOR FUTURE BBQ, GAS
Work: STUB TO FIREPIT
Owner Contractor
MICHAEL WATLING CAL/PACIFIC POOLS&SPAS INC
28488 BOARDWALK COURT 17130 VAN BUREN BLVD STE 47
MENIFEE, CA 92585 RIVERSIDE, CA 92504
Applicant Phone:9517762002
GARY SOPER License Number:652876
CAL/PACIFIC POOLS&SPAS INC
17130 VAN BUREN BLVD STE 47
RIVERSIDE,CA 92504
Fee Description ON Amount I$)
Swimming Pool/In-Ground Spa 1 467.00
Plumbing Fixtures and Vents,fixtures 1 116.00
Gas System 1 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 3.00
SMIP RESIDENTIAL 1 8.00
General Plan Maintenance Fee-Electrical 1 23.35
$760.35
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 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_BIdg_Permd_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 License Law).
I hereby affirm under penalty 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 Class C S 3 License No. 6r=�7� By mysignature below I acknowledge that,except for my personal residence
Expires 3 31 Signature in which I most have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a stmcture that I
WORKER'S COMPENSATION DECLARATIO 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 maintaina 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# Date
❑I have and will maintain worker's compensation insurance,as required by PROPERLY 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 carrier and policy owner or authorized to act on the property owners behalf.I have read this
numberare: ,f application and the information I have provided is correct.I agree to comply
Carrier Sit.)///j`7N //��7 T l with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#.fPye /07,702- Expires r7 sLZP 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
o 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#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to thewort 'on provisions of Section 3700 of the Labor
Code,I a with comply with t case provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date 3 ^.2 L%` mixture containing hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNIN FAILURE TO E WORKER'S COMPENSATION COVERAGE 15 ❑Yes
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,o00),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 for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes 'PAfm
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 bounda of a school?
(Section 3097 Civil Cade) ❑Yes
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the
Californiaealth&Safety Code,Section 25505 and 25534 concerning
Contractors Ucense hazardardou Law for the reason(s)indicated below by the hazardous erialr porA
checlanark(s)I have placed next to the applicable item(s)(Section 7031.5 Oyes ,efNo
Business and Professions Code).Any city or county that requires a permit to Date —2 'ek
construct,alter,improve,demolish or repair any structure,priorto its PROPERTY OW R AUTHIRIZED AGENT
issuance,also requires the applicant for the permitto file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Cade)or that he or she is exempt from licensure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
receiving compensation for most work that disturbs paint in a pre-197g
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified fines 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.eoMead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-SOD-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:
❑I,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 APPLICATION
Menifee
DATE >i / ( PERMIT/PLAN CHECK NUMBER `Q
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME OOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANR4 of Menifee
`19AEW,CO�PLUMBING O RE-ROOF-NUMBER OFSQUARES Building & Safety D Dpt.
DESCRIPTION OF WORK
PROJECTADDRESS ',bqr r ecelve
ASSESSOR'S PARCEL NUMBER -? S76^Oi 9'-`� LOT 17 TRACT -?y/SQ -3
OWNER NAME nn� l &t/h 7-e-IA/6
P c�
ADDRESS �+ �-� S/sJ a f2ol w 'T -
PHONE ` s'l " �J .�Cs - EMAIL
APPLICANT NAME 'p /ev C v c-s '/ AL7'a/-S
ADDRESS 1 71 3 O Y /g/J✓IL�`y 16-✓ - J�� Y 7 /✓�✓Ll
PHONE nt f I ^ ??(-- X-t�-15 y' EMAIL
CONTRACTOR'S NAME ,L�1 �TioS' OWNER BUILDER? O YES fw
BUSINESS NAME ,- D �/G /�t •I' /J -5x/" .Z�C.-
ADDRESS / 7/ 7b �'?/ ✓/ iY� /4 l j/,O k—Tref 7 11,t62f i '- C o L
PHONE 4' f(^ 776�Lc,1a ` EMAIL
CONTRACTOR'S STATE LIC NUMBER (C� ��'p 7U LICENSE CLASSIFICATION �S`3
VALUATION$ 5-J j-7—60 SQ 7/ ) L SO FT SS
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE ^I VO M- PAID AMOUNT
AMOUNT X : OCASH OCHECK# 0CREDIT CARD VISAIMC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES 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.cityofinenifee.us Inspection Request Line 951-246-6213