PMT16-01404 City of Menifee Permit No.: PMT16-01404
29714 HAUN RD. Type: Pool/Spa-Residential
't;kCCEL_/-> MENIFEE, CA 92586
MENIFEE Date Issued: 05/03/2016
PERMIT
Site Address: 31198 ENSEMBLE DR, MENIFEE,CA Parcel Number: 360-563-007
92584 Construction Cost: $46,300.00
Existing Use: Proposed Use:
Description of INGROUND GUNITE POOL&SPA 433 SO FT, STUB GAS LINE FOR FUTURE FIREPIT
Work:
Owner Contractor
TJ&DANA GALAZZO CAL/PACIFIC POOLS&SPAS INC
31198 ENSEMBLE DR 17130 VAN BUREN BLVD STE 47
MENIFEE, CA 92584 RIVERSIDE, CA 92504
Applicant Phone:9517762002
GARRY SOPEN License Number:652876
CAL/PACIFIC POOLS&SPAS INC
17130 VAN BUREN BLVD STE 47
RIVERSIDE, CA 92504
Fee Description Piz Amount ISl
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 7.00
General Plan Maintenance Fee-Electrical 1 23.35
$526.35
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_Bidg_Permit_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)pursuantt0 the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from Iicensure under the Contractors State License Law for
Professions Code and my license is In full force and effect. the following reason:
License Class 421-3 "eertsrN G By my signature below I acknowledge that,except for my personal residence
y
Expires V^71-/-7 Signatur 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 DE[IA TION 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 copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for workers 70"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 yr,My,leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy If
Date
16,Qave 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.)agree to comply
Carrier r'C ��1i 'Ta! �/H7L with all applicable ci unty ordinances and state laws relating to
buildingparinrtiction.) orize representatives of this city or countyto
Policy# XW G/P}8 Z D ) Expires It- e !>pllfied property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date 'r 6
dollars($100)or less pROPERTV OWN OR AUTHORIZED AGENT
❑I 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#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to th ers ompensa rovisions of Section 3700 of the Labor
Code,I f
nt ort h cpMply with those rovisions. Will the applicant or future building occupant handle hazardous material or a
Appli Date b 4-1 mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:F RE TO SE KER'S COMPENSATION[OVERAGE IS ❑Yes )Dlo
UNLAWF AND SHALL5 ECf ANEMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND OV ESUPiO-ONE HUNDRED THOUSAND DOLLARS($300,000),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 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
hereby affirm under penalty of perjury that I am exempt from the
Contractors License Law for the reason(s)indicated below by the California Health 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.
OYeso
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 Iicensure 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.gov/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 Finn 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 r' 3 PERMIT/PLAN CHECK NUMBER l0' 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 MECHANICAL
O NEWcI O PLUMBING O RE-ROOF-NUMBER OF SQUARES-
DESCRIPTION
DESCRIPTION OF WORK I �3 °�U�U��� / c. '1
PROJECT ADDRESS 3f/ /�� �N.fC QLC` Ad�
ASSESSOR'S PARCEL NUMBER ?CO 00 '7 LOT 7 y TRACT 3a9Q Z
OWNER NAME T fFii/Q y//IJgAl9 AGA12.0
ADDRESS tiJ
PHONE 9f/^ 3O I - 8 `I GO EMAIL
APPLICANT NAME 1,0,964 AIL fJ0<-C ! 10597 e-j
ADDRESS 7v ZV dr A/
PHONE qti -776 - Sao ZD E,MAILIL. I�
CONTRACTOR'S NAME �6niG (i�o•-s ®7,p/�oJ OWNER BUILDER? O YES/at,NO
BUSINESS NAME
ADDRESS l7OZSG '!7v UI,&� 1—PW. S'Tf 'C� f ���E�✓7�✓tr qf.
PHONE 9si 77G /EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 6 36b — S 3 LSQFT /
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CA:) CITY OF M�NIFEE BUS�yE55110ENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN O� SMIP Q `III F.!•
INVOICE r.N ^}J PAIDAMOUNT AMOUNT ITT 0CASH 0CHECK# `�CREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT --CASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES 0 NO
City of Menifee Building&Safety Department29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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