PMT16-00991 City of Menifee Permit No.: PMT16-00991
29714 HAUN RD.
�ACCELA— MENIFEE, CA 92586 Type: Pool/Spa -Residential
MENIFEE Date Issued:
04/04I2016
PERMIT
Site Address: 27003 EMERALD COVE CT, MENIFEE, Parcel Number: 333-471-034
CA 92585 Construction Cost: $32,590.00
Existing Use: Proposed Use:
Description of INGROUND GUNITE POOL&SPA, 116 L FT GAS/ELECTRIC LINE FIREPIT& BBQ
Work:
Owner Contractor
JAMES&MICHELLE HARADA PAUL BOGNER POOLS
27003 EMERALD COVE CT 5045 VAN BUREN BLVD
MENIFEE, CA 92585 RIVERSIDE, CA 92503
Applicant Phone: 9516885543
MIKE LANSING License Number:275843
PAUL BOGNER POOLS
5045 VAN BUREN BLVD
RIVERSIDE, CA 92503
Fee Description Oft( Amount lSl
Swimming Pool/In-Ground Spa 1 467.00
Plumbing Fixtures and Vents,fixtures 1 116.00
Building Permit Issuance 1 27.00
Inspections not specified 116 116.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 5.00
General Plan Maintenance Fee-Electrical 1 23.35
$756.35
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_BItlLPemrit_Templale.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'State License Law forth,
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 it
Professions Codg�and mglicense is in full force and eR ct which I must have resided for at least one year prior to completion o
License Class `, Licens No. .5 Improvements covered by this permit,I cannot legally sell a structure that I hav,
-�� bulk as an owner-building If it has not been constructed In its entirety by licensee
F�cpires — Signature contractors. I understand that a copy of the applicable law,Section 7044 of th,
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application t:
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: htto,/Avww.leginfo.m.gov/mlaw.htmi.
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# pBy my Signature below, I certify to each of the following: I am the propert•
I have and will maintain workers' compensation insurance, as required by (owner or authorized to act on the property owner's behalf. I have read thi+
section 3700 of the Labor Cade, for the performance of the work for which this application and the information I have provided is cared I agree to compl-
permit rs fssued.My wo�rkers'co/mpensation insurance certier and policy number are: with all applicable city and county ordinances and stale laws relating to bulldinl
Xk r•'co construction.I authorize representatives of this city or county to enter the above
Cartier � IdenMe pro a for thsi4pection purposes.
Policy#9�Z90.RoG.!/!5 Expires ,�2-1-�� Date
Properly •wnerorAuthorlzedA ent Al IJ91
(This section need not be completed if the permit is for City Business License If oyg 5 io
one-hundred dollars($100)or less)
HAZARDOUS MATERIAL DECLARATION
❑ 1 certify that in the performance of the work for which this permit is issued.I
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 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 amounts specified on the Hazardous Materials Information Guide?
Code,I shall forthwith comply with those provisions. DYES ❑NO
Applicant; Date:/ -- / 'f`Ge Will the intended use of the building by the applicant or future building
occupant require a permit for the construction at modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND AYES ❑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 of a school?
LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES ❑NO
CONSTRUCTION LENDING AGENCY I 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 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) hazardous material reporting.
OWNER BUILDER DECLARATIONS DYES ❑NO
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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,after,improve, demolish, EPA RENOVATION.REPAIR AND PAINTING fRRPI
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 EPNs Renovation Program visit:
roe www.epa.gov/lead or contact the National Lead Information Center at
❑ I, as owner of the p p rly, 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 State License Law does not apply to an owner of a property ❑An EPA Lead-Safe CerOfled 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 Finn 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 Cerifficallm No.:
purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed EI No EPA Lead-Safe Certified Firm 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
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
Acknowledgement
CITY OF MlliNLLJl'lU1L' PLCK No: it
I I
29714 Haun Road Date: Date:
Menifee,.CA 92586
Phone: (951 )672-6777 Amount: Amo
5(0.3
Fax:(951)679-3843 Ck#: Ck#:
Building Combination Permit
S 3l—lctS To Be Completed By Applicant
Des 'ptio �n I 1_ L . Plpnning Case: F: L: - Rt: R
Prope Address: 'K nn Assessor's Parcel Number.
,Q-7 3 R�fYwu-c.l 3-y-71 -D3,-4 -o
Project/Tenant Name: Unit#: Floor#:
Name S: (2m-c Jn 1 I ra_d one"° , - OS 1 I Fax No.
Property Ad5ess
Owner I n Unit Number Zip Code
L l� p
Email Address:
Name: - Phone No.
M% ^�
Applicant Address: C1.)1 1.� krM iVd• i Unit Number - ZipCode�2S�
Email Address: ��ir p Cl� !! p /`-cry C7 0
ame:All ROQ Pon1 ` f Np 5 5"1 � t �O O b � O 3
Contractor A dyers +� . �r-s i d-e� �l�O'S I to Zjp bode
t'1 J-S O
ont ctor's City Business License No. Contractor's ity State of California License No. Classification: /� _e
b 12 I I 1 l
Number of Squares:
Square Footage LA1 f. I
Description of Wor �( ro I .S — C Cost of Work:$32 59 0
1 o r
Applicant's Signature Date:
T°Be Co eted ByCiLy Staf#Only .. .. -
Indicate -Received or N/A-Not Applicable
5 Completes sets of fully dimensioned,drawn to sale plans which incl de: 1 set of documents which include
❑ Title Sheet ❑ Elevations - ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on B%x 11)
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Structural Calculations
❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition" Means/Methods
Work Type: Repair' Retrofit' Revision to Using Permit' Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have a Basement? Y of N
Bldg. Code Occupancy Group Indicate Indicate if
YES or NO Indicate all Geo-tech.Haz.Zone
At Project Construction Sprinklered that apply: Coastal Zone
Completion: Type(s): C Of O Noise Zone
Required? YES or NO
q Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch. Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: - City Project Elec.Vehicle Charger Landmark Seismic Retrofit special Case:Bldg,
Official Approval
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Building/Safety I Permit Specialist I City Planning Civil Engineering EPWM-Admin Transportation Mgmt. I Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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