PMT16-02075 City of Menifee Permit No.: PMT16-02075
29714 HAUN RD. Type: Pool/Spa-Residential
�ACCEL/-? MENIFEE, CA 92586
MENIFEE Date Issued: 07101/2016
PERMIT
Site Address: 28338 NORTHMOORE PL, MENIFEE,CA Parcel Number: 372-392-015
92584 Construction Cost: $20,000.00
Existing Use: Proposed Use:
Description of INGROUND POOL&SPA 540 SQ FT
Work:
Owner Contractor
MICHAEL C MYERS R L J ENTERPRISES
28338 NORTHMOORE PL 36499 CHERVIL WAY
MENIFEE, CA 92584 LAKE ELSINORE, CA 92532
Applicant Phone:9092614516
LEE JOUGLARD License Number: 1007383
R L J ENTERPRISES
36499 CHERVIL WAY
LAKE ELSINORE, CA 92532
Fee Description Qty Amount lSl
Swimming Pool/In-Ground Spa 1 467.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 3.00
General Plan Maintenance Fee-Elechical 1 23.35
$621.35
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
1 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 D I am exempt from licensure under the Contractors State License Law for
Professions Code and mylicense is in full force and effect the following reason:
License Class ( -z�, Lice a No. I ^b 3 By my signature below I acknowledge that,except for my personal residence
Expires9 0-1-7 Signature in which l must have resided for at least one year prior to completion of
improvements covered by this permit I cannot legally sell a structure that 1
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:) 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.leeinfo.ca.eov/calaw.htrnL
Policy# Date
D 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 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.)have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
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($100)or less
PROPERTY OWNER OR AUTHORIZED AGENT
)41
certify that in the performance of thework for which this permit Is Issued,
I shall not emolov 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 the workers compensatici prov ions of Seaton 3700 of the Labor
Code,Ishall forthwt Comply wit hos povisions. /� Willthe applicant or future building occupant handlehazardous material ora
Applicant_G Date_7�/— �C� mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE T S URE WORKER'S COMPENSATION COVERAGE IS Dyes 9kNo
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 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(SC tion or See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forCoast
Airlines
Qua
CONSTRUCTION LENDING AGENCY D Yes LSNo
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility he 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) Dyes rF!No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that 1 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 Health&m hazardous me I I r e porti
Safety Co ,Sec, 25505 and 25534 concerning
r ////
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 DYes
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 PROPER N A 12ED 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 apre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence orchildcarefacilitytobeork tcertifled firms and complywith
than
Applicant fora permit subjects the applicant too civil penalty of not more required practices.This includes rental property owners and property
than($50D). managers who do the paint-disturbing work themselves or through their
D 1,as owner of the property,or my employee with wages as theirsole 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.eoa.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 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:
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 for this project because:
D 1,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 applyto an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
J
Menifee
DATE PERMIT/PLAN CHECK NUMBER I -V Qo
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
,;CNEW OPLUMBING ORE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK SL.�
PROJECTADDRESS ],,+�
ASSESSOR'S PARCEL NUMBER '5 1 a- 3ga-o 15 LOT TRACT I I
OWNER NAME f\
ADDRESS ZP>5 N(n r-Ntpec-
PHONE 95 644-485() EMAIL
APPLICANT NAME d
ADDRESS SA4CIQ ! NI, 92S3 2—
PHONE ?LC4 EMAIL L,
CONTRACTOR'S NAME _ S S `L OWNER BUILDER? O YES P'NO
BUSINESS NAME
ADDRESS Cl E !
PHONE 90Q Zbt A-Sjl EMAIL
CONTRACTOR'S STATE LIC NUMBER job?S62, LICENSE CLASSIFICATION L--53
VALUATION$ ZU S FT L SQ FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIF/�EE BU!0!!YLES
ICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP O J
INVOICE PAID AMOUNT
AMOUNT C CASH C CHECK# C CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT CCASH O CHECK# CCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6 777
WWW.city0 finen ifee.us Inspection Request Line 951-246-6213
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