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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 12- F N f lj�l Nk NN y - L f �` O ` 0 `ems m —GDc1D #S' A W O d Z 0 0 f#'anyaosae {af Sd£LZ 031 a GI Z o o n z OFFICE COPY N a e N T s CD v IA a. lY r m V)K N 1 (o —o' V C I