PMT16-01075 City of Menifee Permit No.: PMT16-01075
29714 HAUN RD. Type: Pool/Spa-Residential
<ACCEL/-> MENIFEE, CA 92586
1-1..rt13 s.A. MENIFEE Date Issued: 04/08/2016
PERMIT
Site Address: 25279 SPUR BRANCH PL, MENIFEE, CA Parcel Number: 358-420-003
92584 Construction Cost: $55,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA 740 SO FT
Work:
Owner Contractor
ROBERT BARRON QUALITY CUSTOM POOLS INC
25279 SPUR BRANCH PL 30138 MARNE WAY
MENIFEE, CA 92584 MENIFEE, CA 92584
Applicant Phone:9516799732
JIM BARRETT License Number:795820
QUALITY CUSTOM POOLS INC
30138 MARNE WAY
MENIFEE, CA 92584
Fee Description l3Yt Amount ISl
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE 1 3.00
SMIP RESIDENTIAL 1 8.00
General Plan Maintenance Fee-Electrical 1 23.35
$528.35
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_Permit Templale.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe 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 and my license is in full force and effect. o the following reason:
License Class C53 — G License No. CI 2 By my signature below I acknowledge that,except for my personal residence
Expires Signature in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that 1
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 7D44 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.IeRinfo.ca.Rcv/caIaw.htmL permit is issued.
Policy N Date
[ten,)have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
ssection 3700 of the labor Code,for the performance of the work for which C�5p 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 on 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"E.c c.St 0'1JO--t 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# rAk df12(0(-1 Expires��II 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
❑I certify that in the performance of the work forwhich this permit is issued, �.f+� Gt_---) 2r2
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE g C) VV J Z7
workers compensation laws of Califomia,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 rthwith cp t911yy with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant (t d�--�`'�T' Date "1• `a ��O mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide.
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes COO
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)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY ❑Yes (*0
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 10DO feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) ❑Yes OR-14o
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 far the reason(s)indicated below by the California Health&Safety Code,Section 25505 and Z5534 concerning
hazardous material repo ng.
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5
Business and Professions Code).Any city or county that requires a permit to es /
construct,alter,improve,demolish or repair any structure,prior to Its PR o Date gJ (o
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 Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRPj 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-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 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.epamov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-BOG424-LEAD(5323).
Code;The Contractors State License Law does not apply to an ownerof 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.
CITY OF MJuNY3'EE PLCK No: P "t I - 075�
29714 Haun Road Date: Date:
Menifee, CA 92586
Phone: (951)672-6777 Amount Amount:
Fax:(951)679-3843 Ck#: Ck#:
Building Combination Permit
To Be Completed By Applicant
Legal Description: �1 Planning Case: F: L: Rt: R:
Property Address: 9
5271 -5 R r� Assessor's Parcel Number?ra-1�h.Ob03
Project/Tenant Name: Unit W. �� Floor#:
Name: J' ^r� , �2R G Phone No. Fax No.
Property Address: Unit
�C' Unit Number Zip Code
Owner T J2 r
Email Address:
Name: / Phone No. Fax No.
( ate �i2s
Applicant Address: Unit Number Zip Code
Email Address:
Name: Phone No. Fax No.
r', S( ri 73� 30/ �333
Contractor Address: City Stye Zip Code
J (
Contractor's City ustness Icense No. Contractor's City State of California License No. Classirication:^
Number of Squares:
Square Footage —7 Q
Description of WorkGUnr�� ast of Work:$
Applicant's Signature / Date:
To Be Completed By City Staff Only
Indicate As R-Received or N/A-Not Applicable
5 Completes sets of fully dimensioned.drawn to sale plans which include: 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(an 8%x 11)
❑ Structural Calculations
❑ Foundation Plan ❑ Cross Section _ ❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan I ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addifion` Means/Methods
Work Type: Repair* Retrofit* Revision to Existing Pelnlit' 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 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 I bpe0 roval�
Expedite Project(s): Child Care City Project Green Building I ILandmarki IAffordable Housing
For Staff Use Only
8uildin /Safer Permit Specialist City Planning Civil Engineering EPWM-Admin Tranap or[a ion gmt. Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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