PMT16-01355 City of Menifee Permit No.: PMT16-01355
29714 HAUN RD.
�-A-CCELA> MENIFEE, CA 92586 Type: Pool/Spa -Residential
.. . '" MENIFEE Date Issued:
04/28/2016
PERMIT
Site Address: 28372 LITTLE LAKE CT, MENIFEE, CA Parcel Number: 333-401-043
92585 Construction Cost: $30,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA 450 SF WITH 150' U/G GAS& 150'U/G ELEC LINES FOR FUTURE BBQ
Work:
Owner Contractor
LANCE MCLAUGHLIN BERMUDEZ BELTRAN PROPERTY MGMT INC
28372 LITTLE LAKE COURT 1058 WEST KING STREET
MENIFEE, CA 92585 BANNING, CA 92220
Applicant Phone: 9092414764
JOSUE BERMUDEZ License Number:929858
BERMUDEZ BELTRAN PROPERTY MGMT INC DBA CREATI
1058 WEST KING STREET
BANNING, CA 92220
Fee Description Qtv Amount 151
Swimming Pool/In-Ground Spa 1 467.00
Plumbing Fixtures and Vents,fixtures 1 116.00
Plumbing Fixtures and Vents, fixtures 1 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 4.00
General Plan Maintenance Fee-Electrical 1 23.35
$755.35
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_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 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 licenseis in full force and effect.^p c� �i thefollowing reason:
License Class Cot / License No. !�C / O J/) By mysignature 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 I
WORKER'S COMPENSATION DECLARAi ION 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 wwwiecinfo.ca.eov/calaw.html.
this permit is issued.
Policy Jt Date
❑I 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 on the property owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
Policy 0 Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT
—>d'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 CITY BUSINESS LICENSE Jt
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 forthwith comply with thos provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date OL mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARN :FAILURE TO SECURE W RKER'S COMPENSATION COVERAGE IS ❑Yes ❑No
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 UPTO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TOTHE 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 ❑No
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 boundary of a school?
(Section 3097 Civil Code) ❑Yes ❑No
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
Contractors License Law for the reason(s)indicated below by the hazardous
mate al Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.
oyes ❑No
Business and Professions Code).Any city or county that requires a permit to Date
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 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(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-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.epa.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 forthis 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
Cade: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.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
Menifee
DATE 1%j PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL }RESIDENTIAL O MULTI-FAMILY O MOBILE HOME POOL/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 CrJ I S
PROJECT ADDRESS 02- O 3 (off I It le- I d rUU(- ' -Ifql 11`ee SK5
ASSESSOR'S PARCEL NUMBER 333-401- Ok3 LOT TRACT
OWNER NAME Za I ev-i /4cLcujh) Ikj
ADDRESS c2 /I' fre I uI(P C UUC+ Mevl i Per 1,CA C1 2 S&S
PHONE EMAIL
APPLICANT NAME ` Vn V P City of Menifee
y ept.
ADDRESS G�'�- W .l Vl
PHONE /691.p, '11-1('7 EMAIL APR 2 IS Z016
CONTRACTOR'S NAME OWNER BUf@
BUSINESS NA/ME C'' a v� c -_ y
ADDRESS �[O 0 G^,LS ` /1
PHONE /? -Q --,-174 y rEMAIL
CONTRACTOR'S STATE LIC NUMBER /02� �S (f LICENSE CLASSIFICATION a e2
VALUATION$ 15! C10o SO FT 4150 L SQ FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BU51NE55 LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
LV
INVOICE �'t �j,� PAID AMOUNT O
AMOUNT 1� •../V �� 0CASH CHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# OOCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 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.cityo/menifee.us Inspection Request line 951-246-6213