PMT16-01804 City of Menifee Permit No.: PMT16-01804
29714 HAUN RD.
�CCEL/►7. MENIFEE, CA 92586 Type: Pool/Spa-Residential
r.�..,.,..<sNr.R•• MENIFEE Date Issued: 0 611 012 01 6
PERMIT
Site Address: 28364 PARKDALE LN, MENIFEE,CA Parcel Number: 372-391-008
92584 Construction Cost: $35,000,00
Existing Use: Proposed Use:
Description of INGROUND GUNITE POOL AND SPA,418 SF
Work:
Owner Contractor
RAFAEL&SUZETTE PEREZ TEMECULA VALLEY CUSTOM POOLS INC
28364 PARKDALE LANE 27315 JEFFERSON AVE#J 100
MENIFEE, CA 92584 TEMECULA, CA 92590
Applicant Phone: 9512022393
DAVID THOMPSON License Number.818695
TEMECULA VALLEY CUSTOM POOLS INC
27315 JEFFERSON AVE#J 100
TEMECULA, CA 92590
Fee Description Qtt t Amount ISl
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 5.00
General Plan Maintenance Fee-Electrical 1 23.35
$624.35
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
with a licensed contractors)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter!)(commencing with section 7000)of ivision 3 h usin and o 1 am exempt from Iicensure under the Contractors State License Law for
Professions Code and my license is( force an ct the following reason:
License Class G License By my signature below I acknowledge that,except for my personal residence
Expires / Signatu in which 1 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
o I hereby affirm under penalty of perjury one of the followi)r 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 ,n„nty,leeinfo.ca.eov/calaw.html.
this permit Is Issued.
Policy# Date
❑1 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 o 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
Cartier building construction.I authorize representatives of this city or county to
Policy# 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 00)or less PROPERTY OWNER OR AUTHORIZED AGENT
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 f Cal' mia,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to orker n to provisions of Section 3700 o the Labor
Code,I all forthw' omp y t rose provisions. Q Will the applicant or future building occupant handle hazardous material or
mixture containing a hazardous material equal to or greater that the
Applica Date amounts spec' ed on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SE RE WORKER'S COMPENSATION COVERAGE IS ❑Yes ssiCI
UNLAWFUL,AND SHALL S ECTAN 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 Quali Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelin
CONSTRUCTION LENDING AGENCY nYes o
1 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 bougr of a school?
(Section 3097 Civil Code) D Yes ENo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
itt,I hereby affirm under penalty of perjury that I am exempt from the hecklist I understa my requirements under the State of
California Health a ety ,Section 25505 and 25534 concerning
Contractors License Law forthe reason(s)indicated below by the hazardous ate al reporti
checkmark(s)I have placed nextto the applicable ftem(s)(Section 7031.5 Oyes o
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 ORAU ORIZEDAGEFIT
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.REPAI 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
o 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.ena.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 D 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:
sate.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. D No EPA Lead-Safe Certified Firm is required for this project because:
o 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
•�1
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
..."'Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL '!✓RESIDENTIAL O MULTI-FAMILY O MOBILE HOME W OOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION - LECTRICAL O MECHAW4,'ty of Meni e
Ing & Safet Dept.
WNEW PLUMBING ORE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK rV,04217-6 O L 4 f.---�4 JUN 10 2 16
ReceivAd
PROJECTADDRESS 29,3% f}/C["Ak,6
ASSESSOR'S PARCEL NUMBER S-14- :35tj'(" oq, y�LOT L�. C TRACT
OWNER NAME lT�'�'L-'�
ADDRESS 6�f" L/ .
PHONE EMAIL
APPLICANT NAME �gtJl1� Ia,J
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME / (p Fe OWNER BUILDER? O YES /✓NL5'�
BUSINESS NAME TEMECULA VALLEY CUSTOM POOLS,INC.
27315 Jefferson Ave.#J
ADDRESS
PHONE 7(li�ZO2• Z 3y 3 // EMAIL ��fOOC-`; OL.Goeu
CONTRACTOR'S STATE LIC NUMBER 9 LICENSE CLASSIFICATION
VALUATION $ Q S ` LSQFT
APPLICANT'S SIGNATURE DATE •� l
DEPARTMENTDISTRIBUTION �G^ CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP J
INVOICE PAID AMOUNT
AMOUNT � O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.citycfinenifee.us Inspection Request Line 951-246-6213
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