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PMT16-02143 City of Menifee Permit No.: PMT16-02143 29714 HAUN RD. <ACCELA—> MENIFEE, CA 92586 Type: Pool/Spa-Residential MENIFEE Date Issued: 07/08/2016 PERMIT Site Address: 31809 BRENTWORTH ST, MENIFEE, CA Parcel Number: 372-431-006 92584 Construction Cost: $20,000.00 Existing Use: Proposed Use: Description of INGROUND POOL&SPA 400 SQ FT Work: Owner Contractor RAFILA BURT GABRIELS POOL PLASTERING&CEMENT 31809 BRENTWORTH ST 4410 DWIGHT AVENUE MENIFEE, CA 92584 RIVERSIDE, CA 92507 Applicant Phone: 5627128928 STEVE CLARK License Number: 988199 GABRIELS POOL PLASTERING&CEMENT 4410 DWIGHT AVENUE RIVERSIDE, CA 92507 Fee Description Oft Amount I$) 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-Electrical 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 81dg Pennit_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). Chapter!)(commencing with section 7000)of Division 3 of the Business and o I am exempt from ILcensure under the Contractor's State License Law for Professions Code anmyly license is in full force and effect. the following reason: License Class v"y License No.9z' p Z/C -7 By my signature below I acknowledge that,except for my personal residence Expires ✓,zZ 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 hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section aye 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 fallowing website: by Section 3700 of the labor Code,for the performance of work for which w,,s„n,.leeinfo.ca.eov/calaw.htmL this permit is issued. Policy# % ;rj�r 7 Date I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,forthe 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 compensa ion insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this number are: A application and the information I have provided is correct.I agree to comply Cartier -,�/ ���///111 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 o I certify that in the performance of the work for which this permit is issued, QL 31-/G O O I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# VV J / J workers compensation laws of California,and agree that if I should became HAZARDOUS MATERIAL DECLARATION subject to the worker' mpensation provisions of Section 3700 of the Labor Code,I shall f/oJrth'v�'tf/i/comply with thos provisions. Will the applicant or future building occupant handle hazardous material or a Applicant; /! Date amountsre specified iedong a theH Hazardus ous Marial terials Ivto or ationrthatthe -z. amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes r)(No 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(SCAQMD)7 See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines CONSTRUCTION LENDING AGENCY • tiYes 4No 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 agencyfor the performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) Dyes oe° OWNER BUILDER DECLARATIONS I 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 California Health&Safety Code,Section 25505 and 25534 concerning Contractors License Law for the reason(s)Indicated below by the hazardous material eporting. checkmark(s)I have placed next to the applicable Rem(s)(Section 7031.5 r3Ses o 0 >� / Business and Professions Code).Any city or county that requires a permit to ,�G2 aw-vt Date construct,alter,improve,demolish or repair any structure,prior to its PRO 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 licensure 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.epa.apv/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. o No EPA Lead-Safe Certified Firm 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 4} ;Menifee DATE - PERMIT/PLAN CHECK NUMBER 12H f(o • oa 43 TYPE: 0 COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL (NNEW O PLUMBING C) RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK DOG �DNS� PROJECTADDRESS ,lam/80�j' f2Ei✓���tyyd��D Y/��T/+� �jT, ([� ASSESSOR'S PARCEL NUMBER j51a �-4 '0+ LOT GrH TRACT OWNER NAME ADDRESS PHONE spa-yQ(� �Aj EMAIL APPLICANT NAME ADDRESS .U- j' -3 PHONE EMAIL Uri CJ �LGO!/f� Cum CONTRACTOR'S NAME y�l/� OWNER BUILDER? O YES ONO BUSINESS NAME"'��` ADDRESS /��j'W//, �7 /-� PHONE _nq - Z.%Z-lrf�S� EMAIL CONTRACTOR'S STATE LIC NUMBER &fl / LICENSE CLASSIFICATION VALUATION$ ZO DJt/ SO FT L SO FT �Za APPLICANT'S SIGNATU DATE DEPARTMENT DISTRIBUTION r11 -.2AV CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN f I_ SMIP (/ INVOICE PAID AMOUNT AMOUNT • OCASH OCHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT I O CASH O CHECK N O CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 city of MeniteO SITE PLAffNI f IAI BuiWing & safety Dept- JUL b a 2bl,3 c or J.Biedenbach R.C.E. E)Qail pool Engineering,Inc. Structural clowils shall take precedence over conflicts with site plan. 41 ..... .... .... .. CITY OF MENI :EE BUILDING i ND SAFETY bEPARTMENT PLANAPPR )qAL REVIEWED 1Y DATE 'Approval of these Lp-), rued tobea permit for,oran approval of,any violation of any Provisions of the federal,state or city regulations and ordinances. This set of approved plans must be kept on the jobsite until completion.