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PMT16-01552 City of Menifee Permit No.: PMT16-01662 _ 29714 HAUN RD. Type: Pool/Spa-Residential <X C A? MENIFEE, CA 92586 MENIFEE Date Issued: 0 611 712 01 6 PERMIT Site Address: 27824 LUCERNE DR, MENIFEE, CA Parcel Number: 92585 Construction Cost: $28,000.00 Existing Use: Proposed Use: Description of INGROUND POOL AND SPA-690SF, 6'GROTTO WITH WATERFALL, FIREPIT&FIRE BOWLS Work: Owner Contractor MARK&MARIA DELAOSA PACIFIC COAST POOLS INCORPORATED 27824 LUCERNE DR 43020 BLACKDEER LOOP#106 MENIFEE, CA 92585 TEMECULA,CA 92590 Applicant Phone:9512960199 BRANDY CORAL License Number: 852237 PACIFIC COAST POOLS INCORPORATED 43020 BLACKDEER LOOP#106 TEMECULA, CA 92590 Fee Description O—.t Amount I51 Swimming Pool/In-Ground Spa 1 467.00 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 $639.35 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_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)pursuant to the Contractors State License law). Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure underthe Contractors State License Law for Professions Code and my license is in full force and effect. the following reason: License Class Li ee�No. a5z2aLz By my signature below I acknowledge that,except for my personal residence Expires ZJq 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 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 workers 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 this permit is Issued, www.leginfo.ca.gov/calaw.html. Policy# Date o I have and will maintain workers compensation Insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Cade,for the performance of the work for which 0 By my signature below I certify to each of the following:1 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 numberare: l.Y v`� — 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# ( SZ�xphes ( 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 0 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 1 should become HAZARDOUS MATERIAL DECLARATION subjectto the orkers compensation provisions of Section 3700 of the Labor Code,I shal f rth ith comply with those provisions. ,( (D Will the applicant or future building occupant handle hazardous material or a Applicant Date '/ � I� 7 mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:F ILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0 Yes DIN& UNLAWFUL,AND SHALL SUB1ECf 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 constSCtionor modification See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo Coast Airlines Qua CONSTRUCTION LENDING AGENCY ❑Yes /6INo 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 bour�ry of a school? (Section 3097 Civil Code) 0 Yes ❑No OWNER BUILDER DECLARATIONS 1 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 for the reason(s)indicated below by the California Healt &Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 hazardw-T—leRiflireporting. Business and Professions Code).Any city or county that requires a permit to oyes ❑No construct,alter,improve,demolish or repair any structure,prior to its Date 7� issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRPI License Law(Chapter9(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 apre-197B and the basis for the alleged exemption.Any violation it Section of not by residence or childcare facility to be RRP-certified firms and comply with than Applicant fora Perm itsubjects the applicant toacivil 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 o 1,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 0 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. o No EPA Lead-Safe Certified Firm is required far this project because: 0 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. & SAFETY PERMIT/PLAN CHECK APPLICATION apt. r MAY 17 2016 Menifee DATE PERMIT/PLAN CHECK NUMBER " o I S S TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME OL/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 PDol , z2N , v90t)jT PROJECTADDRESS JW q 'L ASSESSOR'S PARCEL NUMBER 3$3 — 1 '.& U LLOT TRACT SLI 14 O O OWNER NAME ADDRESS g =Y PHONE — 4G�I -� U?j EMAIL APPLICANT NAME ADDRESS as PHONE EMAIL CONTRACTOR'S NAME OWNER BUILDER? O YES O NO BUSINESS NAME j ADDRESS PHONE � (_P pL�� EMAIL CONTRACTOR'S STAT`E]LICC NNUMBER $15-7 170 LICENSE CLASSIFICATION VALUATION$ (/✓t I�� SO.FT �LL� L SO FFT,�I j�1 APPLICANT'S SIGNATURE DATE TYSTAFFUSEONLY •DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES C NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-6 72-6 777 www.citycfinenifee.us Inspection Request Line951-246-6213 .b.L �� WOO2j `d0 •uoiialdWo3liiun ai!sgof sueld panoidde}o s si41 •saoueupu'puesQoiiejnEaj iapa}a4i jo suoisi jd Aue jo uopejop Aue'}o jeeaidde of panjisuoi q iou pegs suepi'asayi;o Jenmddy;'•,• �9 0 iA8 03M31A3U co VAObddb NVId 0 LHVd30 341v' s Q Mall 8 3331N3W 3 l.0 , /I\ .0 (3•L_ M Lr ��9 Q + Q£+ g t � M N _ C7 aInld3=1 2A3 2J33HS .98 CINV 3NC 33-LVM 1N3030 H-LIM Wd39 (INC